Reminder - Unprocessable (Return/Reject) Claims Must Be Resubmitted

Reviewed May 31, 2013

Posted November 20, 2009

If a claim contains incomplete or invalid information it is returned as unprocessable or rejected. The easiest way to identify a rejected claim is with the following Claim Adjustment Reason Code (CARC):

CO-16: Claim/service lacks information which is needed for adjudication.

Unprocessable claims do not have reopening or redetermination rights and must be corrected and submitted as a new claim due to the fact that the initial claim is missing important information that is needed for processing or the claim information that was submitted is invalid.

Note: Resubmitting an unprocessable claim will not cause a duplicate denial as long as the item being billed was not previously paid for the same beneficiary with the same date of service.

For additional information on determining what claims are accepted via the reopenings process, please access Chapter 8 of the DME MAC A Supplier Manual.

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