Medicare Remittance Review - Part 4 ( Denial and Solution)

Alert: If you do not agree with what we approved for these services, you may appeal our decision. To make sure that we are fair to you, we require another individual that did not process your initial claim to conduct the appeal. However, in order to be eligible for an appeal, you must write to us within 120 days of the date you received this notice, unless you have a good reason for being late.

We can appeal any of Medicare rejection but it should be with 120 days from the EOB date.

Alert: The claim information has also been forwarded to Medicaid for review.

Medicare automatically forward the primary EOB to secondary insurance so there is no need to send a secondary claim.

Claim submitted as unassigned but processed as assigned. You agreed to accept

assignment for all claims.

It says that all the claims will be considered as accept assignment claim even we uncheck the box 25.

Alert: Your claim has been separated to expedite handling. You will receive a separate notice for the other services reported.

This codes saying that our claims has been seperated for easy processing so Medicare will pay or deny other claims.

Missing/incomplete/invalid name or address of responsible party or primary payer.

For all the secondary claims, we should include primary insurance details.

Missing/incomplete/invalid patient relationship to insured.

For Medicare the relationship always self, Check this info in your claim and rebill.

Missing/incomplete/invalid social security number or health insurance claim number.

Check the id.

Missing/incomplete/invalid principal diagnosis.

Check the primary Dx.

Correction to a prior claim.

Its is a correction of previously paid claim and for clear picture see the previous EOB.

Did not indicate whether we are the primary or secondary payer.

All the claim should be indicated as primary or secondary. Top of the CMS -1500

Missing/incomplete/invalid patient's relationship to the insured for the primary payer.

Again the relationship should be Self.

Missing/incomplete/invalid employment status code for the primary insured.

Missing/incomplete/invalid group practice information.

Check the Provider ID. BOX 33.

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