Unprocessable Claim Rejections and Corrections
Unprocessable claims are medical claims that cannot be processed by Medicare Part B National Government Services, because they contain incomplete, missing or invalid information.
- Incomplete Information: Required data fields are incomplete, such as the patient's date of birth, insurance information, or the service provider's NPI.
- Missing Documentation: Lack of necessary supporting documentation, like a referral or pre-authorization.
- Invalid Information: Incorrect or illogical data, such as an invalid NPI, a date of service or a diagnosis code that doesn't correspond with the procedure.
Identifying Unprocessable Services
- Message code MA130 appears on your remittance advice indicating the claim is unprocessable.
- Paper claims are screened and if information is missing, the claim is mailed back to you with a form letter indicating why the claim is being returned.
- Electronic claims that fail initial edits will be returned via the acceptance report.
In addition to message code MA130, your remittance advice may include other message codes informing you what information is missing, invalid or incomplete.
See a complete list of Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC) on the X12 website.
Common Errors
- Beneficiary eligibility
- Provider identification
- CPT/HCPCS and modifiers
- Missing total charges
- Claims that are not processed under NGS
Correcting Unprocessable Claims
Unprocessable claims must be corrected and retransmitted/resubmitted as a new claim(s).
- Review RARCs. RARC will state the reason a claim(s) being rejected/returned as unprocessable.
- Correct the errors identified with the claim(s) data or documentation.
- Submit a new claim.
Notes
- No appeal rights are afforded to these claims because no initial determination was made.
- The telephone reopening unit cannot assist with rejected claims.
Related Content
- Top Claim Errors
- Centers for Medicare and Medicaid Services Internet-Only Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 26
- Centers for Medicare and Medicaid Services Internet-Only Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 1
Posted 5/28/2025