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  • Posting Date: 07/18/2025
    34538

    Avoiding/Correcting This Error To avoid this error: When submitting your Medicare primary claim, report the reason Medicare is primary using claim coding in Prevent an MSP Rejection on a Medicare Primary Claim. To correct this [...]

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  • Posting Date: 07/18/2025
    32402

    Avoiding/Correcting This Error Verify HCPCS code using the FISS Inquiries HCPCS file (option 14). Allowable revenue codes will be displayed based on DOS. Use the claims correction option to report the appropriate HCPCS/CPT code and resubmit [...]

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  • Posting Date: 07/18/2025
    38032

    Avoiding/Correcting This Error If duplicate claim was submitted in error, no additional provider action is necessary. If it is determined that the claim was due to additional charges for a patient for a specific date of service, wait for the [...]

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  • Posting Date: 07/18/2025
    38312

    Avoiding/Correcting This Error If appropriate, correct and resubmit a new claim.   To prevent this error on future claims: Ensure you have received all charges from all departments and that no claim has been submitted for the same DOS [...]

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  • Posting Date: 07/18/2025
    39929

    Avoiding/Correcting This Error Verify the line level rejection information to determine the rejection for each of the lines of the claim in question. Resubmit as appropriate. Line level reason code(s) appear on the right view of claim page two [...]

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  • Posting Date: 07/18/2025
    39934

    Avoiding/Correcting This Error Review each line level denial reason code(s). Follow the steps provided in that line level reason code narrative. Line level reason code(s) appear on the right view of claim page two (MAP171D). In order to access [...]

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  • Posting Date: 07/18/2025
    You Asked, We Listened - Introducing the Modifier Lookup Tool

    You Asked, We Listened - Introducing the Modifier Lookup Tool We value and appreciate the feedback from our providers, which drives continuous improvement to enhance your experience. We're pleased to announce the launch of our new Modifier [...]

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  • Posting Date: 07/18/2025
    39934

    Avoiding/Correcting This Error Review each line level denial reason code(s). Follow the steps provided in that line level reason code narrative. Line level reason code(s) appear on the right view of claim page two (MAP171D). In order to access [...]

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  • Posting Date: 07/18/2025
    7K073

    Avoiding/Correcting This Error If the beneficiary is entitled to Medicare Part B, an ancillary claim may be submitted to your MAC. Related Content Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) [...]

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  • Posting Date: 07/18/2025
    U5200

    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 Provider Online System, HETS or NGSConnex to verify beneficiary [...]

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  • Posting Date: 07/18/2025
    U5210

    Avoiding/Correcting This Error Each beneficiary should be screened for eligibility. Part of the eligibility verification process should include ensuring the dates of service fall within the Medicare entitlement period. Use the FISS Provider [...]

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  • Posting Date: 07/18/2025
    Medical Policy and Billing and Coding Updates

    Medical Policy and Billing and Coding Updates LCDs in Notice Period (7/24/2025-9/6/2025) L38367 - Fluid Jet System Treatment for LUTS/BPH Based on a Reconsideration Request, the Indications of Coverage have been revised by removing the [...]

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  • Posting Date: 07/18/2025
    U5233

    Avoiding/Correcting This Error Verify the admission date, from, and through dates on the claim and compare the dates to the HMO entitlement dates. Outpatient facilities and inpatient noninpatient PPS and IRF hospitals, or LTCH billing [...]

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  • Posting Date: 07/16/2025
    Understanding the Reopening and Appeal Process Open Forum

    National Government Services is committed to reducing provider burden associated with Medicare claim denials, reopenings and appeals. Filing an inquiry on a Medicare claim can be frustrating and costly to your organization. This delay in [...]

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  • Posting Date: 07/16/2025
    Understanding the Reopening and Appeal Process Open Forum

    National Government Services is committed to reducing provider burden associated with Medicare claim denials, reopenings and appeals. Filing an inquiry on a Medicare claim can be frustrating and costly to your organization. This delay in [...]

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  • Posting Date: 07/16/2025
    A55

    Avoiding/Correcting This Error Medicare Secondary Payer (MSP) claims must include the primary insurance carrier’s payment information, plan details, and subscriber information. Incomplete or inaccurate entries will result in claim rejection. [...]

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  • Posting Date: 07/16/2025
    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 [...]

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  • Posting Date: 07/16/2025
    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 [...]

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  • Posting Date: 07/16/2025
    OA-18

    Avoiding/Correcting This Error A duplicate claim submission occurs when a provider resubmits a claim either on paper or electronically for a single encounter and the service is provided by the same provider to the: same beneficiary; for the [...]

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  • Posting Date: 07/16/2025
    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 [...]

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