When we have resubmi the claim ?

The only time a claim should be resubmitted is when Remark Code MA130 is reflected on the Remittance Advice. The message attached to MA130 indicates the following: Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable.

Please resubmit the correct information to the appropriate fiscal intermediary or contractor.

Some examples of rejected claims that should be corrected and submitted as new claims are (not an all inclusive list):

• Invalid procedure codes and/ or ICD-9-CM codes
• Missing or invalid performing provider numbers
• Missing drug name and dosage for Not Otherwise Classified codes
• Invalid Health Insurance Claims Numbers
• Services payable by a primary insurer
• ICD-9-CM codes not listed to the highest level of specificity

Payment reopening and re determinations applies to all other errors and denials. Please refer to the Payment Reconsideration section that follows regarding options available on resolving errors and denials. Check the NHIC website frequently for updates to services that may be reopened.

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