Wiki Denial Code CO-109 from Medicare

[M3oonlight]

Hello everyone ,
Needing some assistance with a denial code CO-109 we billed L1830-LT but it came back as unprocessable and to send to correct payor. I am Jurisdiction D . Who do I submit it to? And/ or what modifiers am I missing? Thanks!!

 

[SharonCollachi]

Are you sure that Medicare is the patient's primary insurance? Are you sure they don't have a Medicare HMO or other Medicare replacement plan?

 

[KimNickel]

Go on CSNAP and check the patient’s Medicare eligibility. It will tell you if they have a Medicare advantage plan. If the MCO box is highlighted, click on it and it will tell you which plan they have. That is the most likely cause for the CO-109 denial.

 

[TPeniston61]

Did you send it to the DMERC claims office? This is where you should send it for any DME.

 

[maebelle@gmail.com]

Did you send it to the DMERC claims office? This is where you should send it for any DME.

Is this for all physicians to send DME claims to or just for DME licensed providers? I was under the impression that a provider had to have a DME license to get reimbursed. I'm curious!