Search Results - NGSMEDICARE

Posting Date: 04/09/2025

W7088

Avoiding/Correcting This Error Each FQHC PPS claim must be billed with a qualifying visit code, and associated line-item charges, along with all other FQHC services furnished during the encounter. A qualifying visit code is the code that [...]

Posting Date: 04/09/2025

52MUE

Avoiding/Correcting This Error You have the right to submit an appeal when you believe the medical records support that the denied services were reasonable and medically necessary. Providers should review the information on the CMS website [...]

Posting Date: 04/09/2025

52NCD

Avoiding/Correcting This Error Ensure all Medicare coverage and medical necessity requirements are met prior to billing. If the provider determines that Medicare will not cover the services, consider submitting the charges as noncovered. [...]

Posting Date: 04/09/2025

54NCD

Avoiding/Correcting This Error Review coverage guidelines for the service being denied to ensure medical necessity of the services being provided to the beneficiary. Ensure all Medicare coverage and medical necessity requirements are met [...]

Posting Date: 04/09/2025

52NCD

Avoiding/Correcting This Error Ensure all Medicare coverage and medical necessity requirements are met prior to billing. If the provider determines that Medicare will not cover the services, consider submitting the charges as noncovered. [...]

Posting Date: 04/09/2025

55B31

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 [...]

Posting Date: 04/09/2025

55B31

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 [...]

Posting Date: 04/09/2025

55S29

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, [...]

Posting Date: 04/09/2025

55S05

Avoiding/Correcting this Error The SNF should ensure that SNF services that are not covered are identified. After discussion with the beneficiary and/or representative you should properly issue an ABN and bill for the noncovered services [...]

Posting Date: 04/09/2025

39928

Avoiding/Correcting This Error To access the line level reason associated with this reason code providers should go to claim page (2) (MAP 1712) and F11 to MAP171D to see the line level denial codes for each line of the claim. If you disagree [...]

Posting Date: 04/09/2025

5ND07

Avoiding/Correcting This Error To prevent this error, ensure all Medicare coverage and medical necessity requirements are met prior to billing. Providers can visit the CMS Coverage Database to review the NCDs and LCDs to determine the [...]

Posting Date: 04/09/2025

59118

Avoiding/Correcting This Error Review reason code 59118 in the Direct Data Entry system for applicable codes. Alternatively, review the latest Change Requests/MLN® Matters articles for relevant ICD-10 updates. The most current MLN Matters [...]

Posting Date: 04/09/2025

59118

Avoiding/Correcting This Error Review reason code 59118 in the Direct Data Entry system for applicable codes. Alternatively, review the latest Change Requests/MLN® Matters articles for relevant ICD-10 updates. The most current MLN Matters [...]

Posting Date: 04/09/2025

39928

Avoiding/Correcting This Error To access the line level reason associated with this reason code providers should go to claim page (2) (MAP 1712) and F11 to MAP171D to see the line level denial codes for each line of the claim. If you disagree [...]

Posting Date: 04/09/2025

56900

Avoiding/Correcting This Error This reason code can and should be prevented. When providers receive an ADR, respond according to the date listed in the ADR. Providers should start gathering the documentation being requested immediately. This [...]

Posting Date: 04/09/2025

56900

Avoiding/Correcting This Error Regularly access claims in status locations SB6001, SB6098, or SB6099 to obtain a listing of claims for which records have not yet been received by the MAC (Medical Review Department). Look for information on the [...]

Posting Date: 04/09/2025

56900

Avoiding/Correcting This Error Regularly access claims in status locations SB6001, SB6098, or SB6099 to obtain a listing of claims for which records have not yet been received by the MAC (Medical Review Department). Look for information on the [...]

Posting Date: 04/09/2025

5WEXC

Avoiding/Correcting This Error Ensure all Medicare coverage and medical necessity requirements are met prior to billing. When the provider determines that Medicare will not cover the services, consider submitting the charges as noncovered. [...]

Posting Date: 04/09/2025

56900

Avoiding/Correcting This Error This reason code can and should be prevented. When providers receive an ADR, respond according to the date listed in the ADR. Providers should start gathering the documentation being requested immediately. This [...]

Posting Date: 04/09/2025

5WEXC

Avoiding/Correcting This Error Ensure all Medicare coverage and medical necessity requirements are met prior to billing. When the provider determines that Medicare will not cover the services, consider submitting the charges as noncovered. [...]