eharloff
Networker
First off, I absolutely hate Medicaid with a passion (lol)
I'm located in Michigan and I received a denied claim Adjustment Reason Code 16: Claim/service lacks information or has submission/billing error(s) which is needed for adjudication. Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided.
Here is the Remark Code:
MA125: Per legislation governing this program, payment constitutes in full.
N442: Payment based on an alternate fee schedule.
N131: Total payments under multiple contracts cannot exceed the allowance for this service.
The one highlighted in red is the one I am confused about. This was processed as a secondary claim. Total billed amount was $108.00 which went to her primary insurance, Healthgram Inc., they paid $53.71 and adjusted $29.29, leaving patient's balance $25.00 (co-pay/co-insurance according to EOB). Is Medicaid not covering this because it is patient's copay, and do I write this amount off then? Thanks in advance!
I'm located in Michigan and I received a denied claim Adjustment Reason Code 16: Claim/service lacks information or has submission/billing error(s) which is needed for adjudication. Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided.
Here is the Remark Code:
MA125: Per legislation governing this program, payment constitutes in full.
N442: Payment based on an alternate fee schedule.
N131: Total payments under multiple contracts cannot exceed the allowance for this service.
The one highlighted in red is the one I am confused about. This was processed as a secondary claim. Total billed amount was $108.00 which went to her primary insurance, Healthgram Inc., they paid $53.71 and adjusted $29.29, leaving patient's balance $25.00 (co-pay/co-insurance according to EOB). Is Medicaid not covering this because it is patient's copay, and do I write this amount off then? Thanks in advance!