Medicare denial/reason codes

[jgf-CPC]

Has anyone ever encountered OA-121 "Indemnification adjustment - compensation for outstanding member responsibility" on the EOB? Please explain to me what this means....we have never seen it before and thanks ahead!!!!

[twallmuth]

We called Medicare and the rep did not know. We faxed her a copy of our remittance and are waiting work back.

[tammster]

I believe that's the PECOS warning.

[RenaHall]

This is a possible MSP and/or an unbundling adjustment. Example: TPL is primary carrier is primary, then MC pays secondary. The unbundling is pretty self explanatory. In some states, you bill, for instance, auto carrier first and that carrier allows you to bill E&M with other services that MC would usually not allow. MC would disallow it under OA-121. Hope this doesn't confuse you more.
Rena

[jgf-CPC]

It didn't confuse me at all and thanks for your input....but..... this patient does not have a secondary and is responsible for the balance. I thought at first it had to do with the ABN for this particular procedure but the patient didn't sign one so it was not that either.....this one just puzzles me!!!

[charhal]

We contacted MCR they stated it is warning that the rendering or referring provider is not in PECOS and starting 1-4-2010 the claims will be denied.

[jgf-CPC]

Thanks all!!!!