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Printed Date: 9/22/2015
If your claim was selected for Medical Review and denied, the Railroad Retirement Board Specialty Medicare Administrative Contractor (RRB SMAC) will issue a Claim Review Decision and Education Letter (also called a Granular Denial Letter) to explain why the claim denied.
Each letter will contain the denial code for the claim and the specific granular error finding statement for the code. The following is a listing of codes which may be utilized in a denial of ambulance services:
Top Denials by Denial Code:
NODOC: One of the main reasons for denials is that the documentation requested by the Additional Documentation Request (ADR) letter was not received or did not include the necessary requirements to bill for the service. To avoid this denial, submit all documentation supporting the services billed within 45 days of the date on the ADR letter. Providers will have 45 days to submit documentation related to an ADR request. Please see Medical Review: Additional Documentation Requests (ADRs) for information on how to respond to a documentation request.
NOTMN/ASAVA: Many claims are denied due to inability to support medical necessity of ambulance transport with submitted documentation and/or alternative services were available and should have been utilized. Per Medicare Benefit Policy Manual, Chapter 10, Ambulance, section 10.2.1, “In any case in which some means of transportation other than an ambulance could be used without endangering the individual's health, whether or not such other transportation is actually available, no payment may be made for ambulance services.”
BNSIG: Another top reason for denials is missing beneficiary or authorized representative signature. The beneficiary’s signature, or that of his or her authorized representative, is required prior to filing a claim to Medicare.
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Last Updated: 10/10/2018