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 a specific granular error finding statement for the code. The following is a comprehensive listing of codes which may be utilized in a claim denial:

Denial Code
Denial Code Description
Specific Granular Error Findings
ALTMR
Altered Medical Records.
Original medical record has been altered.
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.
BILER
Billed In Error (Provider indicated claim error.)
Claim billed in error per Provider.
BNSIG
Beneficiary Signature not submitted.
Documentation received lacks the necessary beneficiary or authorized representative signature.
CCNDO
No or partial documentation received:
Chief Complaint Not Documented in the medical record.
 
Documentation requested for this date of service was not received or was incomplete.
DNOTH
Another provider already reimbursed for services.
Services deemed payable to another provider.
DNSRP
Documentation Not
Signed by the Rendering
Provider.
Information submitted contains an invalid/illegible provider signature.
DWNCD
Down Code to lower level of service.
Service is approved at a reduced level.
EMCNM
No or partial documentation received:
E&M Components Not Met (example: billed 99214 and documentation did not meet 2 out of 3 required criteria).
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.
INPCS
Invalid PCS. Provider Certification Statement was incomplete.
Documentation requested for this date of service was incomplete.
INPOC
Invalid provider Plan Of Care (treatment plan).
Documentation received contains an invalid/ incomplete provider plan of care.
ISIGN
Invalid Signature.
Information submitted contains an invalid/illegible provider signature.
ITRNM
Invalid signature: NP/NPP signed but MD billed and "Incident To" Requirements Not Met.
Information submitted contains an invalid/illegible provider signature.
MTHPY
Documentation supports Maintenance Therapy.
These charges are non-covered services; documentation supports Maintenance Therapy.
NOCRD
No Credentials documented for provider.
Provider signature does not include the necessary provider credentials.
NOCXR
No Chest X-ray; no radiology report received.
Documentation received lacks the necessary radiology report.
NODOC
No Documentation submitted.
Documentation requested for this date of service was not received or was incomplete.
NOORD
No order submitted.
Documentation lacks the necessary provider order.
NOPCS
No PCS.
No Provider Certification Statement submitted.
 
Documentation received lacks the necessary Certificate of Medical Necessity.
NOPOP
Not covered by Part B - Pre-Operative.
Services not covered by Part B Medicare.
NOPRB
Not covered by Part B (billed global or only technical component) in POS 21, 22 or 23.
Services not covered by Part B Medicare.
NOPRV
Not covered by Part B – Preventive.
Services not covered by Part B Medicare.
NORUN
No Run report.
Documentation received lacks the necessary Run Report.
NOSIG
No Signature.
Documentation lacks the necessary provider signature.
NOSUP
More than one service billed with modifier 26 & with no supporting medical necessity.
More than one service billed with modifier 26 & with no supporting medical necessity.
NOTIM
Documentation is missing total Treatment Time.
Documentation received lacks the necessary time component.
NOTMN
NOT Medically Necessary. Medical necessity not supported in documentation.
Payer deems the information submitted does not support medical necessity of services billed.
ONSIG
Order not Signed.
Order lacks the necessary provider signature.
ORDNR
Original Document Not
Received.
Information received lacks the necessary patient medical record.
SIGST
Provider signature appears to be stamped.
Documentation contains signature stamp.
TRMIN
Transportation Minimum requirements for Medicare coverage not met.
Payer deems the information submitted does not support medical necessity of services billed.
WRONG
Wrong patient, wrong date of service. Inconsistent information.
Documentation received contains incorrect/incomplete/invalid patient identification or date of service.

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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