The Most Common Reason Medicare Denies Payment

Jurisdiction 11 Part B

Submitting Patient Information: Reminder

Palmetto GBA strongly suggests that you review your patients’ insurance information at each encounter. Carefully checking for changes in coverage effective dates, Medicare plans and numbers will ensure that your claims are submitted accurately.

• Claims submitted with incomplete/invalid information will be rejected as unprocessable (remark code MA130). This is the most common reason that claims are not processed.
• Rejected claims must be corrected and retransmitted/resubmitted as new claims. There are no appeal rights on rejected claims. You may not request a Redetermination or Telephone Reopening for these claims.

INSURED'S I.D. NUMBER
Submit the patient's Medicare Health Insurance Claim Number (HICN), as shown on the patient's Medicare card.

PATIENT'S NAME
Submit the patient's last name, first name and middle initial, if any, as shown on the patient's Medicare card.
Note: Please review the following tips to ensure timely processing of your claim and prevent claims from being rejected.

• The first character of the patient's last name and first name must be alpha
• The only valid characters for the patient's last name and first name fields are:
  • spaces, alpha, hyphen (-), apostrophe ( ' ), period ( . ) or comma ( , )
• If characters other than the ones noted above are submitted, your claim may be rejected
• The patient's middle initial should always be an alpha character

In addition to verifying insurance coverage with the patient, you may also:

• Call the Palmetto GBA IVR to verify patient eligibility:
  • Jurisdiction 1: (866) 931-3903