Ambulance Services Claim Review Decision and Education Letter: Granular Error Denials and Details

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:

Denial Code
Denial Code Description
Specific Granular Error Findings
BILER
Billed In Error (Provider indicated claim error.)
Claim billed in error per Provider.
NOTMN
NOT Medically Necessary. Medical necessity not supported in notes.
Payer deems the information submitted does not support medical necessity of services billed.
TRMIN
Transportation Minimum requirements for Medicare coverage not met.
Payer deems the information submitted does not support medical necessity of services billed.
ASAVA
Alternative Services were Available and should have been utilized.
Alternative services were available and should have been utilized.
ATCCF
Allow Transport to Closest Covered Facility
The documentation received doesn’t support transport to closest facility that can provide the necessary care.
ORDNR
Original Document Not
Received
Information received lacks the necessary patient medical record.
INPCS
Invalid PCS.
Provider Certification Statement was incomplete.
Documentation requested for this date of service was incomplete.
NOPCS
No PCS.
No Provider Certification Statement submitted.
 
Documentation received lacks the necessary Certificate of Medical Necessity
NODOC
No Documentation submitted.
Documentation requested for this date of service was not received or was incomplete.
ILDOC
Illegible Documentation.
Information submitted deemed illegible.
INMIL
Incorrect Mileage
Documentation received contains incorrect/incomplete/invalid mileage.
WRONG
Wrong patient, wrong date of service. Inconsistent information.
Documentation received contains incorrect/incomplete/invalid patient identification or date of service.
NORUN
No Run report.
Documentation received lacks the necessary Run Report.
ISIGN
Invalid Signature.
Information submitted contains an invalid/illegible provider signature.
SIGST
Signature Stamp.
Documentation contains signature stamp.
NOSIG
No Signature.
Documentation lacks the necessary provider signature.
DNSRP
Documentation Not
Signed by the Rendering
Provider.
Information submitted contains an invalid/illegible provider signature.
NOCRD
No Credentials documented for provider
Provider signature does not include the necessary provider credentials.
BNSIG
Beneficiary Signature not submitted.
Documentation received lacks the necessary beneficiary or authorized representative signature.
ALTMR
Altered Medical Records
Original medical record has been altered.
DWNCD
Down Code to lower level of service.
Service is approved at a reduced level.

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.

References:

Contact Railroad Medicare

Email Railroad Medicare

Contact a specific Railroad Medicare department

Provider Contact Center: 888-355-9165

IVR: 877-288-7600

TTY: 877-715-6397

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