Medicare code denial MA130 and action

MA 130 - Claims returned as unprocessable as appeal requests

There are large volume of appeals have been filed on claims that were returned as unprocessable. An unprocessable claim is one that was filed with incomplete and/or invalid information.

Claims that are unprocessable cannot be appealed. Therefore, when a provider files an appeal on an unprocessable claim, the correspondence is returned to the provider with a letter instructing the provider to refile a new claim. Response letters are typically not generated for at least 30-40 business days after the original request was submitted. To avoid delays in payments, providers must resubmit claims returned as unprocessable. Filing an appeal only delays payment on claims and could result in a timely filing denial if the incomplete/invalid claim is not re-filed with the correct information with the timely filing period.

Identifying an unprocessable claim

Claims returned as unprocessable will typically include the MA130 remittance advice message with a corresponding reason code message to denote why the claim was incomplete or invalid.

Communication letters to top providers that file appeals on unprocessable claims

CMS will be sending communication letters to providers in the future if appeals are continually filed on unprocessable claims. These letters will provide details on the number of appeals requests received on unprocessable claims by the applicable providers and the impacts that such requests have on regular appeal and inquiry inventories.



Code/Modifier Combination Invalid and Modifier Invalid/Missing

Remark Code/ Message Number:

4: The procedure code is inconsistent with the modifier used or a required modifier is missing

MA130: Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.

Resolution

Review the CPT/HCPCS code narratives to determine if a modifier is needed

Verify that the submitted modifier is appropriate to be submitted with the procedure code