Jun 12, 2008 | Medical billing basics
MRA reason code CO-50: These are non-covered services because this is not deemed a “medical necessity” by the payer. · Remark message N115: This decision is based on a Local Medical Review Policy (LMRP) or Local Coverage Determination (LCD). An LMRP/LCD provides a...
Jun 12, 2008 | Medical billing basics
MRA reason code CO-140: Patient/Insured health identification number and name do not match. Or, MRA reason code CO-16: Claim/service lacks information which is needed for adjudication. Remark Message MA27: Missing/incomplete/invalid entitlement number or name shown on...
Jun 10, 2008 | Medical billing basics
ANNE My brother, David, worked in the family business too. But he didn’t like it. He wanted to try something different.JOHN So what happened?ANNE My parents agreed. They let him come to Australia to study.JOHN Where did he go?ANNE He came here, to Adelaide. He studied...
Jun 10, 2008 | Medical billing basics
ANNE describes her brother to the private investigator.ANNE Can you help me?JOHN Well I’ll try. Now tell me about your brother Ms Lee. How old is he?ANNE He’s twenty-three.JOHN Well that would make him your younger brother. What’s his name?ANNE David.JOHN And what...
Jun 5, 2008 | Medical billing basics
Identifying yourselfThis is Donna Greenwood.This is Mr. Williams.Jennifer Fisher here.This is Mrs. Jones.This is Frank Stevenson speaking.This is Daniel Adams here.This is Paul Ryefield.Identifying your companyThis is Donna Greenwood of Chemsoft Incorporated.Jennifer...
Jun 3, 2008 | Medical billing basics
Denail reason code CO-16: Claim lacks information which is needed for adjudication. — Remark message MA114: Missing/incomplete/invalid information on where the services were furnished. Resolution Item 32 of the CMS-1500 Claim Form or the electronic equivalent...
Jun 3, 2008 | Medical billing basics
Denial reason code OA-109:Claim not covered by this payer/contractor. The provider must send the claims to the correct payer/contractor. The following should be considered when this message appears on the remittance notice: — Claim not covered by this...
Jun 2, 2008 | Medical billing basics
ANNE is looking for JOHN’s office. A WOMAN is waiting at a bus stop. ANNE approaches her.ANNE Excuse me.WOMAN Yes? ANNE Could you tell me how to get to Mitchell Street?WOMAN Yes. You’re going the wrong way. You need to go straight along here, past the silver balls,...
Jun 2, 2008 | Medical billing basics
In her hotel room, Anne rings a number.John Barbour, the private detective, answers the phone.JOHN Hello, Barbour’s Private Investigation. John Barbour speaking.ANNE Hello. Can you find missing people?JOHN Sometimes we can. Have you lost somebody?ANN Yes.JOHN Perhaps...
May 29, 2008 | Medical billing basics
Top ten Denials 1. Duplicates 2. Claim Not Covered by This Payer/Contractor 3. Missing/Incomplete Information on Where Services Furnished 4. Beneficiary Eligibility 5. Medical Necessity 6. Bundled Services 7. Non-Covered 8. Medicare Secondary Payer (MSP) 9. Provider...
