Reason Code: U5200

Error Description:

CMS’ records indicate that the beneficiary is not entitled to Medicare coverage for the type of services billed on the claim. 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/DDE 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)