Medicare Remittance Review – Part 4 ( Denial and Solution)

Alert: If you do not agree with what we approved for these services, you may appeal our decision. To make sure that we are fair to you, we require another individual that did not process your initial claim to conduct the appeal. However, in order to be eligible for an appeal, you must write to us within 120 days of the date you received this notice, unless you have a good reason for being late.

We can appeal any of Medicare rejection but it should be with 120 days from the EOB date.

Alert: The claim information has also been forwarded to Medicaid for review.

Claim submitted as unassigned but processed as assigned. You agreed to accept

assignment for all claims.

It says that all the claims will be considered as accept assignment claim even we uncheck the box 25.

Alert: Your claim has been separated to expedite handling. You will receive a separate notice for the other services reported.

Missing/incomplete/invalid name or address of responsible party or primary payer.

For all the secondary claims, we should include primary insurance details.

Missing/incomplete/invalid patient relationship to insured.

Missing/incomplete/invalid social security number or health insurance claim number.

Missing/incomplete/invalid principal diagnosis.

Correction to a prior claim.

Did not indicate whether we are the primary or secondary payer.

All the claim should be indicated as primary or secondary. Top of the CMS -1500

Missing/incomplete/invalid patient’s relationship to the insured for the primary payer.

Missing/incomplete/invalid employment status code for the primary insured.

Missing/incomplete/invalid group practice information.

Check the Provider ID. BOX 33.