Denial Reason, Reason/Remark Code(s)
- CO-226: Information from the Billing/Rendering Provider was not provided or was insufficient/incomplete
- MA81: Missing/incomplete/invalid provider/supplier signature
Resolution/Resources:
- The CERT Review Contractor assesses errors when signatures in practitioners’ medical records, including x-ray reports and orders do not meet Medicare requirements. As a result, Palmetto GBA (Ohio/West Virginia) must initiate claim adjustments and recoup any related overpayments from providers.
- If you received Medicare Remittance Advice notification of these errors and disagree with the denials, send a written request for a redetermination (Appeal) to Palmetto GBA. A redetermination is the first level of appeal and must be requested within 120 days of the date shown on the remittance advice notice of the denied services.
- Do not refile the claim. The decision for the denial was based upon CERT’s review of medical records; therefore, it can only be resolved by filing an Appeal with Palmetto GBA.
References
- Ohio: www.PalmettoGBA.com/boh or West Virginia: www.PalmettoGBA.com/bwv
- Go to 'Browse by Topic,' select 'General' and open the article, 'Medicare Part B Medical Records: Signature Requirements, Acceptable and Unacceptable Practices'
- To review additional signature related information for Ohio/West Virginia, go to 'CERT' and select 'General Information'
- Please see: Medicare Program Integrity Manual (PDF, 644 KB), Pub. 100-08, Chapter 3, Section 3.4.1.1 B