Medicare Denials and action - Provider eligibility

Action - Provider not eligible for this service


MRA reason code CO-B7: This provider was not certified/eligible to be paid for this procedure/service on this date of service.
MRA reason code CO-38: Services not provided or authorized by designated (network/primary care) providers.
Resolution
Services were denied because the date of service on the claim is prior to the effective date or after the
termination date of the provider number submitted on the claim.
· The provider should verify the correct date of service appears on the remittance advice. If the date of service on the remittance advice is not correct, the procedures for having errors corrected should be followed.
· If the correct date of service appears on the remittance advice, there may be an issue with the effective date and/or termination date of the provider’s Medicare billing number.
It may be necessary to contact Provider Enrollment at (866) 528-1602 (It will differ state to state).

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