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Thursday, July 8, 2010

Top Five DME MAC Claim Denials for Podiatry Specialty

The top five denials below are for the period of October 2008 through December 2008. These claims were
identified from Specialty 48, which represents Podiatrists. The denials identified are for all of DME
MAC Jurisdiction A Suppliers

Top FiveClaim Denials     # of Denied Claims     Reason For Denial      

CO 96, N115                                       2,371     This decision was based on a Local Coverage Determination (LCD). An LCD provides a guide to assist in determining whether a particular item or service is covered. Non-covered charge(s)    

CO 18, N111                                      2,409     This service was included in a claim that was previously billed and adjudicated. No appeal rights are attached to the denial of this service to determine whether the service/item is a duplicate. Duplicate claim/service    

CO 58                                                   978     Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service    

CO 4                                                        701     The procedure code is inconsistent with the modifier used, or a required modifier is missing     

CO 16, MA130                                         685     Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Claim/service  lacks information which is needed for adjudication   

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