Diabetes Awareness

Common Denials Guide for Diabetes Self-Management Training and Medical Nutrition Therapy

National Government Services, MAC for Jurisdiction K and Jurisdiction 6, continues to provide you with resources to help reduce the burden of claim denials and the appeals process.

Based on our review of Diabetes Self-Management Training and Medical Nutrition Therapy claims, we have put together a list of common denials for these services and the steps to avoid them.

DSMT/MNT Common Denials

Denial Reason Denial Explanation How to Avoid/Correct the Denial
Patient cannot be identified as our insured. You will see this error message when:
  • The patient cannot be identified as our insured, the name or Medicare number was incorrect or missing.
  • The date of death precedes the date of service.
  • Expenses were incurred prior to coverage.
  • Expenses were incurred after coverage terminated.
  • The service was not covered by Medicare at the time the patient received it.
 The provider’s office should get a copy of the beneficiary’s Medicare card and copy the full name and Medicare number as it appears on the card. In addition, make sure to check eligibility, benefits, and coverage dates using NGSConnex.
Missing/Invalid MSP group number. You will see this denial message when there is an incorrect or missing MSP group number on the claim. When Medicare is secondary, enter the beneficiary’s policy or group number and proceed to Items 11a through 11c of the CMS-1500 claim form. Items 4, 6 and 7 must also be completed.
Billing provider eligibility/Individual furnishing DSMT is not accredited by Medicare. This denial message returns if a provider is not a Medicare provider or when our records show the provider is not Accredited by the ADA or ADCES. If the provider is not currently Accredited by the ADA or ADCES, you must contact them to Accredit the DSMT program. If the DSMT program is already accredited, proof of Accreditation must be submitted to NGS's Provider Enrollment Department.
Missing/incomplete/invalid ordering provider primary identifier. You will see this claim denial when:
  • The physician or qualified nonphysician practitioner did not order the training.
  • There is no referral on file.
 The referring/ordering provider’s name and NPI must be located in Item 17 and 17b on the CMS-1500 claim form or the electronic equivalent. DSMT and MNT services each require their own referral, every year.
Beneficiary exceeded the training limit. You will see this denial if the beneficiary has exceeded their MNT or DSMT training limit. Providers can verify hours of training used and remaining via NGSConnex.
Provider of MNT services did not meet provider qualification requirements. This denial message occurs if someone other than a registered dietician or nutrition professional provided the service. Review MNT Program Requirements to make sure the provider meets the qualification requirements to bill for these services: Diabetes Awareness Resources

 

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Revised 11/8/2024