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Tuesday, June 1, 2010

Rejection CO 140, MA 61, CO 96, M117, N286 & N 234

Q: We received a RUC for claim adjustment reason code (CARC) CO 140. What steps can we take to avoid this RUC code?


Patient/insured health identification number and name do not match


A: You received this RUC because the patient/insured health identification number (HICN) and name on the claim do not match. To avoid this RUC in the future:


• Review and make a copy of patient’s Medicare card for patient file.

• If you are a laboratory, radiology department or other entity where the patient, or his/her diagnostic test(s) were referred, obtain and review a copy of the patient's most recently issued Medicare card from the referring source prior to submitting your claim.

• Verify beneficiary Medicare eligibility. Click here for resources to check eligibility.

• Enter patient’s name on claim exactly as indicated on Medicare card.

• Include spaces and special characters if indicated on Medicare card. Exception: ABILITY | PC-ACE™ software does not currently accept special characters; enter space instead.

• Enter patient’s HICN exactly as indicated on Medicare card.

To avoid delay in payment, submit a corrected claim. Claims that are returned as unprocessable cannot be appealed, as an initial determination was not made. 

Denial message code CO 140 ma 61

• Patient/insured health identification number and name do not match (140)
• Missing/incomplete/invalid social security number or health insurance claim number (61)

Reason for denial

• Claim was filed for a patient whose Medicare number does not match the SSA records and CWF

Reason for Medicaid Denial

Service date greater than 30 days from date of birth
Invalid newborn sex code
Bill service under baby’s own identification number.
Bill service under mother’s identification number.
Can't match name on submitted claim to name on recipient file, name mismatch


How to resolve and avoid future denials

• Review the patient’s file to locate a copy of the Medicare card. If copy has not be obtained:

* Contact the patient for the information

* Call the referring/ordering physician to obtain the information

• File a new claim with the correct name and Health Insurance Claim Number (HIC) as listed on the Medicare card including Alpha Suffix.

Denial message co 96 and M117

• Non-covered charge(s) (96)
• Not covered unless submitted via electronic claim (117)

Reason for denial

• Claims were received in hard copy format

How to resolve and avoid future denials

• Submit claims electronically in the HIPAA complaint 837 format
• If you must submit hard copy claims, contact EDI Technology Support Center to appeal your filing status
• EDI Technology Support – 1-866-749- 4301

 CO-96  Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

M117  Not covered unless submitted via electronic claim.


Common Reasons for Message

    Claim was submitted on paper CMS-1500 Claim Form but provider is required to submit electronic claims

Next Step

    Resubmit claim electronically

Claim Submission Tips

    Verify ability to submit paper claims
    If individual provider is part of a group with an electronic claim submission requirement, then all members of group must submit electronically


Denial message CO 16 AND N286

• Claim/service lacks information which is needed of adjudication (16)
• Missing/invalid/incomplete referring provider primary identifier (286)


Reason for denial

• Claim was filed with a invalid or missing NPI in Item 17B of CMS 1500 Claim Form

How to resolve and avoid future denials

• Refile the claim with the valid referring provider NPI in Item 17B of the CMS 1500 Claim Form

Denial message co 16 N234

• Claim/service lacks information needed for adjudication (16)
• Missing/incomplete/invalid last seen visit date (234)

Reason for denial

• Claim was not submitted with a 6-digit or 8-digit date patient was last seen by their attending physician

How to resolve and avoid future denials

• Routine foot care
*  Item 19 of CMS 1500 claim form
• Include a 6-digit (mm/dd/yy) or an 8-digit (mm/dd/yyyy) date patient was last seen by his/her attending physician
• Include the NPI of the patient’s attending physician

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