Credentialing, Enrollment and Revalidation

Credentialing, Enrollment and Revalidation Table of Contents Requirements Facilities that are not qualified Qualifications Application Forms You Will Need Required Application Fee Documentation State Survey, Tie-in Notice [...]

CO-16

Avoiding/Correcting This Error This denial message is specific to chiropractic claims with CPT/HCPCS codes that are not billable by Medicare enrolled chiropractors. Medicare Part B coverage for chiropractic care is limited to spinal [...]

CO-16

Avoiding/Correcting This Error This rejection is the result of submitting a CPT/HCPCS code without a required modifier. You are required to research the proper modifier to report with the CPT/HCPCS code then submit a new claim. Please use [...]

CO-16

Avoiding/Correcting This Error The billing provider's information on the claim is missing or invalid. To avoid this error, ensure the following details are accurate and included: the billing provider's NPI, name, address, ZIP code and phone [...]

CO-16

Avoiding/Correcting This Error The MBI is necessary for all claims submitted to MAC. Claims without a correct MBI are rejected, requiring providers to verify and resubmit them. To avoid this, use the Eligibility Lookup in NGSConnex before [...]

CO-16

Avoiding/Correcting This Error Certain services require the name and NPI of the ordering or referring physician, depending on the service type. Definitions: Referring Physician: Requests an item or service for a Medicare beneficiary. [...]

CO-109

Avoiding/Correcting This Error Palmetto GBA is the Medicare Administrative Contractor for processing claims of railroad retirees, regardless of their location. Providers and suppliers must verify patients' Medicare entitlement before [...]

Coverage Criteria and Frequency Limits

Coverage Criteria and Frequency Limits Table of Contents Counseling to Prevent Tobacco Use Diagnosis Coding Cost Sharing Reimbursement Nonparticipating Providers Related Content [Return to Top] Counseling to Prevent Tobacco Use [...]

Counseling to Prevent Tobacco Use and Tobacco Related Diseases Job Aid

April 2025 EDI Front End Quarterly Release

April 2025 EDI Front End Quarterly Release Please be advised that while the Centers for Medicare & Medicaid Services mandated release for April 2025 was installed the weekend of 4/6/2025, the code set updates included with this release [...]