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Sunday, February 20, 2011

Home health billing denial

Reason code descriptive narrative and tips to correct and/or avoid future denials.

This claim is denied for payment because the provider failed to submit documentation requested by the intermediary within 45 days. Sections 1815(a) and 1833(e) of the Social Security Act state that providers must submit documentation upon request as a condition of Medicare payment. Medical review requests documentation for various reasons by sending the provider a request for additional documentation, also known as an ADR. Each ADR has a date in the left-hand corner. If we do not receive the requested information within 45 days of that date, the claim is denied

Avoiding/correcting this denial:

*  Providers are advised to regularly access claims in status location SB6001 to obtain a listing of claims for which records have not yet been received by the Fiscal Intermediary (Medical Review).

*  Providers may wish to sign up to receive ADRs electronically. Please contact EDI at (877) 386-1056 for further information on this option.

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