Part B Insider (Multispecialty) Coding Alert

Published on Wed Jul 30, 2003 PDF

Part B carrier AdminaStar Federal recently posted a list of the top ten reasons it denied Indiana physician claims in April. Experts say this list reflects common errors across the country. The ten biggest claims problems were:
 
1) Duplicate claim to ones already processed (reason code 18). This reason accounted for 51 percent of denied claims.
 2) The claim should be sent to another payor first (reason code 22). This accounted for 14 percent of denied claims.
 3) Missing or invalid UPIN (reason code MA102)
 4) The claim doesn't have an appropriate HCPCS modifier (reason code M78)
 5) The claim is unprocessable because it contains incomplete or invalid information. Refer to the remark code for more info. (reason code 60)
 6) The patient didn't have Medicare Part B coverage. (reason code 27)
 7) The carrier doesn't have any record of coverage for the patient's Medicare number included on the claim. (reason code 31)
 8) Medicare won't cover this service in the place or facility where it was provided. (reason code 58)
 9) The time for filing is expired (reason code 29)
 10) The procedure codes and/or rates are incomplete or invalid (reason code M51).