Monday, April 25, 2016

Denial Action on Medicare code MA61, MA27, N256, MA112 AND M79

Beneficiary name and/or Medicare number
MA61: Missing/incomplete/invalid Social Security number or health insurance claim number (HICN).
MA36: Missing /incomplete/invalid patient name.
MA27: Missing/incomplete/invalid entitlement number or name shown on the claim.

• Review and make a copy of patient’s Medicare card for file and verify eligibility. For additional information, click here for beneficiary eligibility Frequently Asked Questions (FAQs).
• Enter patient’s name on claim as indicated on Medicare card.

• Include spaces and special characters if indicated on Medicare card. Exception: PC-ACE software currently does not accept special characters; enter space instead.
• Enter patient’s HICN exactly as indicated on Medicare card.

Billing entity/provider
N256: Missing/incomplete/invalid billing provider/supplier name.
N257: Missing/incomplete/invalid billing provider/supplier primary identifier.
N258: Missing/incomplete/invalid billing provider/supplier address.
MA112: Missing/incomplete/invalid group practice information.

Refer to Item(s) 33 and/or 33A on the claim form. These are required fields. Enter the billing provider/supplier name, address and zip code in Item 33, and the billing provider’s, or group’s, NPI in Item 33A.

Charges on claim
M79: Missing/incomplete/invalid charge.

• Refer to Item 24F on the claim form. Medicare does not pay for services when a charge is not indicated. Enter a charge for each service listed on the claim..

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