Medicare denial co 31 & 140 , co 38 , co 62 and co 63

CO 31 AND 140

Patient cannot be identified as our insured.
Patient/Insured health identification number and name do not match.

Check the patient details including patient name, id and DOB. Correct it and resubmit the claims.

First we have to check the card copy, cross verify the member id with the card copy and update the correct member id and resubmit the claim.

Check if the billed to correct payer, if not as per card copy back side, submit the claim to the correct mailing address.

If there is no card copy in the system, then call the patient and request to fax the card copy or double confirm the member id, subscriber information, claim mailing address and the payer to be bill, according to the patient response act on the same.

CO 38

Services not provided or authorized by designated (network/primary care) providers.

Check the CPT which was submitted. If you submitted the wrong CPT just rebill with correct CPT otherwise take w.o

CO 62

Payment denied/reduced for absence of, or exceeded, pre-certification/authorization.

Resubmit the claims with authorization number.

co 63

Correction to a prior claim.

This is the correction of previously processed claims which was processed in wrong manner.It may be additional amount or they taking backing paid amount which was paid already.

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