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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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