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).

October through December, 2019, Quarterly Total Denials

JM Part A Denial Code
Claim Count w/Denial Code
% Denied to Total w/any Denial Code
% Denied to Total excluding RTPs
140,103
32.4
3.5
66,072
15.3
1.7
24,375
5.6
0.6
17,620
4.1
0.5
12,311
2.8
0.3
11,628
2.7
0.3
10,223
2.4
0.2
9,684
2.3
0.2
7,936
1.9
0.2
7,811
1.8
0.2
6,443
1.5
0.2

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Reason Code 13314 12/16/2019
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Reason Code 14610 12/16/2019
Reason Code 1461A 12/16/2019
Reason Code 15202 12/16/2019
Reason Code 15701 12/16/2019
Reason Code 17701 12/16/2019
Reason Code 19301 12/16/2019
Reason Code 19401 12/16/2019
Reason Code 30905 12/16/2019
Reason Code 30906 12/16/2019
Reason Code 30912 12/16/2019
Reason Code 30928 12/16/2019
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