Reason Code: 55B31
Error Description:
This claim was denied after Medical Review. It was determined that the documentation needed to make payment was missing/incomplete (e.g., incomplete documentation to support therapy units billed).
Avoiding/Correcting This Error
Review coverage guidelines and patient records to determine if all appropriate documentation was sent for review that may have supported medical necessity.
When you receive an ADR from National Government Services, pay particular attention to the information that is being requested which will be listed on the ADR including:
- the dates of service being requested
- a list of documentation to submit
To assist with your ADR documentation preparation, a list of suggested service-specific documentation to submit is included in the ADR letter. While this is not an all-inclusive list, it can be useful for gathering the appropriate records to submit
If all relevant records were not submitted and could support medical necessity, providers may consider filing an appeal.
Related Content
- Appeals section of our website