Reason Code: 55S29
Error Description:
The claim was denied due to missing documentation required to support the services billed. The documentation lacked evidence that all benefit category requirements were met and necessary criteria.
Avoiding/Correcting This Error
Respond promptly to a MAC, CERT, RAC, SMRC, or UPIC request for additional documentation. Documentation is necessary to verify compliance with a benefit category requirement. Ensure that all records, including any treatment notes, certifications, etc. are submitted promptly to support that all billed services were rendered, meet reasonable and necessary criteria, and any additional coverage requirements.
Related Content
- CMS Internet-Only Manual 100-08, Medicare Program Integrity Manual, Chapter 3, Section 3.2.3.8 - No Response or Insufficient Response to Additional Documentation Requests, Item C -Insufficient Response
- Social Security Act Section 1815
- 42 Code of Federal Regulations Part 424.5(a)(6)