Understand Reason Codes on Medicare Claims!
Preventing and knowing how to resolve Claim Submission Errors by understanding the reason codes will help expedite the processing of your claims and may save time and money.
As a Medicare provider you are responsible for ensuring the information submitted on your claims is correct and compliant with Medicare regulations. You should be aware that action may be taken when you demonstrate a pattern of submitting claims inappropriately, incorrectly or erroneously.
To assist providers with this effort, the Jurisdiction 11 Part A Claims Submission Error Help tool has been updated. Palmetto GBA created the tool which includes resources for assisting in resolving and preventing the top claim submission errors made by Medicare providers. Providers can access reasons for errors and tips for correcting claims in plain language. Providers may notice that when accessing reason code descriptions in the Fiscal Intermediary Shared System (FISS) or Direct Data Entry (DDE), the narrative may include descriptions for all applicable bill types.
The Claims Submission Error Help tool has been tailored to include narrative language applicable to all Part A bill types. Providers can either scroll through reason codes in numerical order or use the Palmetto GBA search engine to search by reason code.
Data analysis reports generate the top fifteen claim submission errors made by J11 providers. All codes on the Claims Submission Error Help Tool are reviewed quarterly for accuracy. Codes are added, updated or removed based on data analysis reports.