Common Reasons for Denial

• Item billed does not have base equipment on file. Main equipment is missing therefore Medicare will not pay for accessories or supplies. Suppliers must ensure that the beneficiary-owned equipment information is on file with Medicare Fee- for-Service (FFS) to avoid denials.
• This normally occurs when base item is provided prior to becoming Medicare eligible.
• Examples of items beneficiary owned are Positive Airway Pressure (PAP) devices, BiPAPs, nebulizers, all glucose monitors, and humidifiers, etc.

Next Step to Resolve

• Supplier must provide beneficiary owned Information to Medicare to place on file. Required on file:
• Beneficiary owned item HCPCS; approximate purchased month and year
• Good example: Bene-owned E0601 pur Jan 2021 (approximate)

Methods to Place Information on File for Claims Processing

• If a denial is received with Reason Code 16, Remark Code M124 and to avoid adding narrative to every claim
  • Telephone reopening through the Supplier Contact Center - Request beneficiary owned equipment information be placed on file for accessories or supplies being billed for those items.
  • Written reopening
    • NMP appeals process
    • Mail
    • Fax
• Add required information to the narrative of every claim line for supplies
• Item 19 of the 1500 claim form or the 2400/NTE segment of an electronic claim until the base item has been placed on file. Claims lacking any one of the elements above will be denied for missing information.
• Current denial can also be resolved by adding beneficiary owned narrative to denied claim and resubmitting claim (this does not add beneficiary owned equipment information to history for beneficiary on subsequent claims and will need to be added through telephone reopenings)

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

How to Avoid Future Denials

• Suppliers must ensure that the beneficiary-owned equipment information is on file with Medicare Fee- for-Service (FFS) to avoid denials.
• Suppliers can check Same or Similar on the Noridian Medicare Portal or through the Noridian Interactive Voice Response (IVR) System to ensure that beneficiary owned equipment is on file prior to submitting claims for accessories or supplies.