Article Detail - JA DME
Resolving Denials for a Date Span Overlap or Overutilization
If you have received a denial with Reason Code 150 or 151 and Remark Code N115 on a remittance advice, either there is a date span overlap or overutilization on the claim. Determine next steps to resolve and avoid future denials on the Denial Code Resolution page on the Noridian Medicare website.
- Review claim submitted for frequency limits listed in the LCD and Policy Article and either adjust amounts because it may be supplier liable, or appeal claim with documentation to support medical need.
- Review Medically Unlikely Edit (MUE) tool for maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service.
- To adjust the date span based on medical records available to the supplier, suppliers may do a self-service reopening in the Noridian Medicare Portal.
- A redetermination request may be submitted with all relevant supporting documentation. Noridian encourages redeterminations/ appeals be submitted using the Noridian Medicare Portal. Review applicable Local Coverage Determination (LCD), LCD-related Policy Article, and Documentation Checklists prior to submitting a request. Noridian encourages redeterminations be submitted using the Noridian Medicare Portal.
Last Updated Mon, 27 Mar 2023 15:17:07 +0000