Reason Code: U5200

Error Description:

Inpatient services are reported on the claim and the beneficiary’s Part A coverage is not in effect; or outpatient services are reported on the claim and the beneficiary’s Part B coverage is not in effect. Therefore, no Medicare payment can be made.

Avoiding/Correcting This Error

Part of the eligibility verification process should include ensuring the dates of service fall within the Medicare entitlement period. Use the FISS Provider Online System, HETS or NGSConnex to verify beneficiary eligibility prior to claim submission.

Related Content

• Avoid Return to Provider and Claim Rejections-Enhancing the Beneficiary Eligibility Verification Process
• HIPAA Eligibility Transaction System (HETS)