Balance Bill Patients if You Encounter Error Codes H20203, H45255

Providers who receive rejection codes H20203 and/or H45255 will need to balance bill their patients’ supplemental payers for any balances left after Medicare. Specifically, CMS Medicare FFS Provider e-News instructs:

  • Providers that received rejection code H20203 on their provider notification letters issued from their FI or A/B MAC will need to balance bill their patients’ supplemental payers for any balances left after Medicare.
  • If physicians/practitioner and supplier offices see this rejection code, they will need to balance bill their patients’ supplemental payer for any balances remaining after Medicare.

Defects in the Centers for Medicare & Medicaid Services (CMS’) coordination of benefits (COB) Health Insurance Portability and Accountability Act (HIPAA) 837 compliance editing caused the rejections. Both errors, which affected very few claims overall, have been fixed. Full information can be found on the CMS Outreach and Education website.

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