Reason Code 36428 - JE Part A

Reason Code Narrative

MAMMOGRAPHY BILLING - EITHER THE PROVIDER CERTIFICATION INDICATOR IS EQUAL TO 'N' OR 'SPACES' OR THE CLAIM STATEMENT COVERS FROM DATE IS NOT EQUAL TO OR FALL WITHIN THE EFFECTIVE DATE AND TERM DATE OF ANY OF THE THREE POSSIBLE OCCURRENCES OR WHEN NO TERM DATE, MUST BE EQUAL TO OR GREATER THAN EFF DT FOR THAT OCCURRENCE. EFFECTIVE FOR CLAIMS WITH DATES OF SERVICE ON AND AFTER 01/01/18, THE DIFFERENTIATION BETWEEN FILM AND DIGITAL MAMMOGRAPHY HAS BEEN ELIMINATED.

Common Reason Code Errors

• The claim is being returned due to the billing provider not being certified to perform mammography services.

Common Reason Code Corrections

• Verify the provider credentials and resubmit if authorized to perform mammography services.
  • If you believe you received this reason code in error, please call customer service at 855-609-9960, Option 3: Provider Enrollment.
  • Fax the information to Noridian at 701-277-6572. Allow 2-3 business days to update information.
    • The FDA Issued Certificate (including the FDA Issue Letter stating approval for 3-D Tomosynthesis, if applicable)
    • Certification Number
    • Provider Transaction Access Number (PTAN)
    • National Provider Identifier (NPI)
    • Tax Identification Number
    • Contact Information for the submitter (name, phone number, and email address)

Resources

• Mammography Certification
• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Section 20