Level 1: Redetermination Request Form

Ensure Accurate Provider Enrollment Information on File

Ensure Accurate Provider Enrollment Information on File ATTENTION: Claims and Provider Enrollment Verify that accurate provider enrollment information is on file with Medicare. Are you familiar with the details identified in the PECOS system [...]

Medical Review: Targeted Probe and Educate Review Topics

Jurisdiction K HHH Targeted Probe and Educate: Medical Review Topics Topic CPT Code(s) Common Denials Resources Home Health Medical Necessity N/A 55H3V– The documentation did not support the medical [...]

Understanding the Approval Recommendation Process for Certified Providers

Understanding the Approval Recommendation Process for Certified Providers The certified provider completes and submits a CMS-855 enrollment application and all supporting documentation to its MAC, including any state require documentation [...]

CO-16

Avoiding/Correcting This Error Certain services require the name and NPI of the ordering or referring physician, depending on the service type. Definitions:  Referring physician: Requests an item or service for a Medicare beneficiary. [...]

CO-16

Avoiding/Correcting This Error This denial message is specific to chiropractic claims with CPT/HCPCS codes that are not billable by Medicare enrolled chiropractors. Medicare Part B coverage for chiropractic care is limited to spinal [...]

CO-22

Avoiding/Correcting This Error During patient registration it’s important for office staff to identify whether a beneficiary’s claims should be covered by other insurance before, or in addition to, Medicare. Providers shall use [...]

PR-31

Avoiding/Correcting This Error Services were denied for one or more of the following reasons: The name or Medicare number was incorrect or missing. The date of death precedes the date of service. Expenses were incurred prior to coverage. [...]