Article Detail - JA DME

Denials for missing information on claim, specific to missing indication of whether the patient owns the equipment that requires the part or supply that is being billed continues to be at the top of denials that suppliers receive.

The denial on the remittance advice displays as Reason Code 16/Remark Code M124. This denial will be received if the beneficiary owns a base item that requires supplies used with the base item and the item is not on file in the claim history with Medicare.

Resolving Denials for item not on file in claim history

• Call the Supplier Contact Center to complete telephone reopening to add beneficiary owned equipment for items that require accessories or supplies. First supply claim requires narrative:
  • Beneficiary owned HCPCS; purchased month and year.
  • Good example: Bene-owned E0601 pur Jan 2021
  • Once item purchased on file, subsequent supply claims do not require narrative.
  • Examples of the items are Positive Airway Pressure (PAP) devices, BiPAPs, nebulizers, all glucose monitors, and humidifiers, etc.
• A written reopening may also be submitted with all beneficiary owned equipment information, HCPCS code of base equipment owned, and date equipment purchased. This can be accomplished through mail, fax or Noridian Medicare Portal through the appeals function.