Unprocessable Claims and Remittance Notices

Remittance Notices

After Medicare processes a claim, a remittance advice, with final claim information, goes to the physician. Each service is shown with an explanation of Medicare allowances and payments as well as appropriate deductible or denial information. In addition to this notice, Medicare notifies the benefi- ciary with a Medicare Summary Notice, Explanation of Medicare Benefits, or Notice of Utilization.

The type of notification that the beneficiary receives depends on the carrier or intermediary process- ing the claim.

Unprocessable Claims

The term return as unprocessable refers to the Medicare process for notifying a physician that his or her claim cannot be processed, due to certain incomplete or incorrect information. Once the errors are corrected, the claim may be resubmitted and considered for payment. A physician is required to submit a Medicare claim for beneficiaries who have received services regardless of whether or not the physician accepts assignment. Therefore, a physician who has not accepted assignment on a claim is required to correct claims returned as unprocessable so that a determination can be made on the claim. Unlike denied claims, claims returned as unprocessable do not have appeal rights.

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