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  • Posting Date: 07/16/2025
    CO-109

    Avoiding/Correcting This Error This denial is received when your Medicare patient is enrolled in an MA plan, instead of “traditional fee-for-service” Medicare. MA plans are health plans offered by private companies approved by Medicare [...]

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

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  • Posting Date: 07/16/2025
    PR-31

    Avoiding/Correcting This Error Services were denied for one or more of the following reasons: The name or Medicare number was incorrect or missing. The date of death precedes the date of service. Expenses were incurred prior to coverage. [...]

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  • Posting Date: 07/16/2025
    Care Coordination Services for FQHC/RHC Claims Improperly Paid

    Care coordination services for FQHC and RHC providers are being reimbursed incorrectly. According to CR 13581, they should be paid at the national nonfacility fee rate, but FISS is using the facility fee rate.

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  • Posting Date: 07/16/2025
    CO-109

    Avoiding/Correcting This Error This denial is received when your Medicare patient is enrolled in a MA plan, instead of “traditional fee-for-service” Medicare. MA plans are health plans offered by private companies approved by Medicare that [...]

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

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

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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
    PR-31

    Avoiding/Correcting This Error Services were denied for one or more of the following reasons: The name or Medicare number was incorrect or missing. The date of death precedes the date of service. Expenses were incurred prior to coverage. [...]

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

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  • Posting Date: 07/16/2025
    CO-22

    Avoiding/Correcting This Error During patient registration it’s important for office staff to identify whether a beneficiary’s claims should be covered by other insurance before, or in addition to, Medicare. Providers shall use [...]

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  • Posting Date: 07/16/2025
    CO-22

    Avoiding/Correcting This Error During patient registration it’s important for office staff to identify whether a beneficiary’s claims should be covered by other insurance before, or in addition to, Medicare. Providers shall use our [...]

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  • Posting Date: 07/16/2025
    MLN Connects® Newsletter: July 16, 2025

    MLN Connects® Newsletter: July 16, 2025 CY 2026 Proposed Payment Rule CMS Proposes Bold Reforms to Modernize Hospital Payments, Strengthen Transparency, and Put Patients Back in Control News CMS Expands Access to Lifesaving Gene [...]

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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
    W7050

    Avoiding/Correcting This Error Verify billing and, if appropriate correct and return the claim. Online providers should press PF9 to restore the claim. Related Content Centers for Medicare & Medicaid Services Internet-Only Manual [...]

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  • Posting Date: 07/16/2025
    Top JK Part B Claim Errors are Available

    Top JK Part B Claim Errors are Available We conduct a comprehensive data analysis on a quarterly basis to update and disseminate the latest insights on the most common claim errors. This initiative provides:  Claim Error Reason Code [...]

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  • Posting Date: 07/16/2025
    Top J6 Part B Claim Errors are Available

    Top J6 Part B Claim Errors are Available We conduct a comprehensive data analysis on a quarterly basis to update and disseminate the latest insights on the most common claim errors. This initiative provides: Claim Error Reason Code [...]

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

    Read More