To view lists of the current Medicare-specific reason/denial codes and the remark codes, open the PDF documents below or visit the Washington Publishing Company (WPC) Web site at www.wpc-edi.com/codes.
Once your claim has been processed, Palmetto GBA will send you a Remittance Advice that will provide you with details on your finalized claim. The Remittance Advice contains message codes that explain how a claim was processed. There are three different sets of codes that are used on the Remittance Advice: reason codes, group codes and Medicare-specific remark codes and messages.
Reason codes are used to explain why a claim was not paid or how the claim was paid. They also show the reason for any claim financial adjustments, such as denials, reductions or increases in payment.
Medicare-Specific Remark Codes
Medicare-specific remark codes are used to convey information about remittance processing or to provide a supplemental explanation for an adjustment already described by a claim adjustment reason code. Each Remittance Advice remark code identifies a specific message as shown in the Remittance Advice remark code list.
Tip: Get on the fast track to understanding Medicare Remittance Advices by reviewing the CMS guide Understanding the Remittance Advice for Professional Providers (PDF, 11.28 MB).