Thursday, July 22, 2010

Lack of information on claim denial

CO 16, CO 207 N265, N286
Missing / incomplete / invalid ordering provider
primary identifier.

Item 17A and 17B
17a - If using the UPIN number this must be proceeded by the qualifier 1G then enter the CMSissued
UPIN of the physician listed in item 17
17b - Enter the NPI of the physician as soon as it is available.
Note: The UPIN can be reported until May 22, 2008.

CO 16 MA130
Claim service lacks information which is needed for adjudication. Your claim contains incomplete
and/or invalid information, and no appeal rights are afforded because the claim is unprocessable.

Item 11 - If other insurance is primary to
Medicare, enter the insured’s policy or group
number. If no insurance primary to Medicare
exists, enter “NONE.” If Medicare is primary Item
11 must state the word none, N/A or a blank are
not acceptable.

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