Reason Code 16 | Remark Code M60

Code Description
Reason Code: 16 Claim/service lacks information or has submission/billing error(s)
Remark Code: M60 Missing Certificate of Medical Necessity


Common Reasons for Denial

  • An initial Certificate of Medical Necessity (CMN) or DME Information Form (DIF) was not submitted with claim or on file with Noridian

Next Step

How to Avoid Future Denials

  • To verify a CMN or DIF is required, refer to applicable Local Coverage Determination (LCD), LCD Policy Article
  • For proper claims processing, attach initial CMN or DIF to claim
    • Supplier must submit initial CMN or DIF for item billed
  • If an initial CMN or DIF is posted to Common Working File (CWF) under another jurisdiction, include a comment on claim
  • Ensure all the front end acknowledgement reports from the electronic transmission with CEDI are worked by supplier staff or clearinghouse, to ensure the CMN/DIF is put on file


Last Updated Thu, 14 Oct 2021 20:03:22 +0000