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Published Date:04/08/2019
Printed Date: 9/22/2015
URL: http://palmgba.com/marlowe/redesign6/article.html
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).
April through June, 2019, Quarterly Total Denials HHH Denial CodeClaim Count w/Denial Code% Denied to Total w/any Denial Code RTPs% Denied to Total Excluding RTPs 31947 35,407 30.8 1.5 38157 14,015 12.2 0.6 38200 11,308 9.9 0.4 U538I 10,541 9.2 0.4 U5233 4,681 4.4 0.2 U538F 4,578 4.0 0.2 U5211 3,469 3.0 0.1 C7010 2,775 2.4 0.1 39011 1,738 1.5 0.1 56900 2,193 1.9 0.1
31947
35,407
30.8
1.5
38157
14,015
12.2
0.6
38200
11,308
9.9
0.4
U538I
10,541
9.2
U5233
4,681
4.4
0.2
U538F
4,578
4.0
U5211
3,469
3.0
0.1
C7010
2,775
2.4
39011
1,738
56900
2,193
1.9
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Last Updated: 7/01/2019