Article Detail - JA DME

Same or similar continues to be one of the top denials' suppliers receive. Our Denial Code Resolution Tool assists suppliers in resolving those denials and avoiding them in the future.

Same or similar denials can be identified with Reason Code 151, Remark Code M3 on the remittance advice. To resolve the denial, an appeal/redetermination request may be submitted with all relevant supporting documentation, such as:

• Documentation to support change in beneficiary's medical condition that supports need for a similar item
• Documentation/statement to indicate if item was lost, stolen, or irreparably damaged and what occurred
• Advance Beneficiary Notice of Noncoverage (ABN), if applicable

Prior to providing an item, suppliers should verify if a beneficiary has received a same or similar item. That can be accomplished in the Noridian Medicare Portal. If a same or similar item is on file in the beneficiary's claim history, an Advance Beneficiary Notice of Noncoverage (ABN) should be obtained prior to providing the item.