Medicare Top ten denials (2) - Claim Not Covered by This Payer/Contractor

Denial reason code OA-109:

Claim not covered by this payer/contractor. The provider must send the claims to the correct payer/contractor.

The following should be considered when this message appears on the remittance notice:

--- Claim not covered by this payer/contractor. Claims must be sent to the correct payer/contractor.

---The patient is enrolled in a Health Maintenance Organization (HMO), also known as Medicare Advantage or replacement plans or Medicare+Choice.


Resolution

Beneficiaries are able to enroll in and disenroll from Medicare Advantage/

Medicare+Choice plans annually. Patient screening is vital for an office. Offices should verify the patient’s eligibility by calling the IVR before seeing the patient. This will assist in determining if the patient has changed from traditional Medicare to a Medicare Advantage/Medicare+Choice plan and allow the claim to be submitted to the correct insurance plan the first time. Providers and/or their billing staffs may verify this type of eligibility by calling the IVR for assistance

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