Reason Code 96 | Remark Codes MA44 M117

Code Description
Reason Code: 96 Non-covered charge(s).
Remark Codes:
MA44 and M117
  • No appeal rights. Adjudicative decision based on law.
  • Not covered unless submitted via electronic claim.

 

Common Reasons for Denial

  • Billed claim hard copy on 1500 form and no waiver on file.
  • The ASCA requires that every Medicare supplier submit claims electronically with a few exceptions. The Medicare contractor sends a letter to the supplier requesting documentation that the supplier meets one or more of the conditions necessary to be excused from submitting claims electronically. The subject line of the letter is "Exhibit C-Request for Documentation Form Provider Selected For Review to Establish Entitlement to Submit Claims on Paper." The supplier is instructed to respond to the Medicare contractor by requesting an ASCA waiver, within 30 days of the Review letter and include documentation to support their response.
  • If the ASCA waiver is granted, the supplier is notified in writing.

Next Step

How to Avoid Future Denials

  • Submit claim electronically until ASCA waiver is received by the Medicare contractor to allow hard copy claims to be submitted.

 

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