Reason Code 7NDOC - JE Part A

Reason Code Narrative

RAC COMPLEX REVIEW CMS DOCUMENTATION GUIDELINES NOT FOLLOWED.

Common Reason Code Errors

• The Recovery Auditor (RA) has determined based on information received from Additional Document Request (ADR) that CMS guidelines for documentation were not followed on claim

Common Reason Code Corrections

• A Redetermination may be submitted if provider feels that sending additional documentation will support need for service(s) provided and they do not agree with RA decision. Request should include:
  • All applicable supporting medical documentation
  • Corrected UB-04 form
• If agree with RA decision, providers can submit Part B claims for reasonable and necessary Part A hospital claim denials. Also known as A/B rebilling.

Direct Data Entry (DDE) users can view remarks section for additional clarification.

Resources

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 4, Section 240.1
• Remittance Advice Remark Code List

View reason code list, return to Reason Code Guidance page.