Claims Submission Error Help

Understand Reason Codes on Medicare Claims!
Preventing and knowing how to resolve Claim Submission Errors (CSEs) by understanding the reason codes will help expedite the processing of your claims and may save time and money.

The CSE Help tool may assist you in your compliance efforts by providing information about how to resolve incorrect denials and avoid rejections.

Data analysis reports generate the top CSEs made by providers, which shows the Top 10 denial reason codes in ranking order and the total count of denied claims. This count includes denied, rejected or returned to provider (RTP) claims. The Percent of Denied Claims are given as both including and excluding RTP claims found in T status in the Fiscal Intermediary Shared System (FISS).

Quarterly (July-September) Total Denials

JM Part A Denial Code
Claim Count w/Denial Code
% Denied to Total w/any Denial Code
% Denied to Total excluding RTPs
167,100
27.7
4.4
149,528
24.8
3.9
57,802
9.5
1.5
27,006
4.4
0.7
22,336
3.7
0.6
10,537
1.7
0.3
13,833
2.3
0.4
11,124
1.8
0.3
9,420
1.5
0.3
9,056
1.5
0.2

 

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