Article Detail - JA DME

One of the top denials suppliers continue to receive is the base equipment not on file or not payable. The denial on the remittance advice displays as Reason Code 16/Remark Code M124. As a reminder:

• If a beneficiary owns a base item that requires supplies used with the base, the base item must be on file, in the claim history, with Medicare to avoid denials.

If you are billing claims with this requirement the claim narrative must include three pieces of information:

• HCPCS code of base equipment; and,
• A notation equipment is beneficiary-owned; and,
• Date beneficiary obtained equipment (approximate)

Good example: Bene-owned E0601 pur Jan 2021

Once the beneficiary-owned item is placed on file, subsequent supply claims do not require a narrative.

If you have added the narrative but continue to receive denials indicating the information is not on file, please utilize the following options to ensure the information has been added to the beneficiary’s record.

• Call Telephone Reopenings through the Supplier Contact Center
• Submit a Written Reopening using the Noridian Medicare Portal appeals process
• Mail
• Fax