Monday, July 30, 2012

Provider not certified denial - what need to be done

CO B7 Provider was not certified/eligible to be paid for this procedure/service on this date service


Resources/tips for avoiding this denial

Services were denied because the date of service(s) on the claim is prior to the effective date or after the termination date of the Medicare enrollment of the billing provider who appears on the claim.

• Ensure to submit only claims for services during which the provider had active Medicare billing privileges.

• If services were provided prior to or after a provider's Medicare billing privileges were active, this denial will be received.

Tips to correct the denied claim

Verify the correct date of service(s) appears on your Medicare Remittance Advice (RA).

• If the date of service(s) on the RA is not correct, the procedures for correcting claims errors should be followed.

• Clerical error reopening requests to correct the date of service can be performed.

• If the date of service(s) is correct, there may be an issue with the effective or termination date of the provider’s Medicare billing number.

0732 Servicing Provider Invalid 

Verify the 10 digit number entered for the servicing provider.

0022 Servicing Provider is Not Eligible to Bill this Payment Request Type

The servicing provider billed on the claim is not eligible to bill this claim.

1357 NPI Servicing Provider Not on File

Verify the 10 digit NPI entered for the servicing provider.

0731  Servicing Provider Not Eligible on DOS

The servicing provider was not eligible on the date of service. Contact Provider Enrollment Unit.

0757 Servicing Provider Can Not be a Group Provider

The servicing provider number used on your claim can’t be a group NPI number.

0756 Billing Provider is not a Group Provider

The billing provider must be enrolled as a group provider. Contact Provider Enrollment

0730 Servicing Provider Not a Member of the Group

The servicing provider is not a member of the group provider, Contact Provider Enrollment

0480 Not CLIA Certified to perform procedure

check that the CLIA number used on the claim is certified to perform the procedure.

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