Reason Code 109 | Remark Code N104

Code Description
Reason Code: 109 Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor.
Remark Code: N104 This claim/service is not payable under our claim’s Jurisdiction area. You can identify the correct Medicare contractor to process this claim/service through the CMS website at CMS.gov

 

Common Reasons for Denial

  • Claim was submitted to incorrect Jurisdiction
  • Claim must be submitted to the Jurisdiction listed as the beneficiary’s permanent address with the Social Security Administration

Next Step

  • Submit claim to correct Jurisdiction listed as beneficiary’s permanent address with the Social Security Administration. This can be verified in the Noridian Medicare Portal
  • Determine which DME MAC jurisdiction the claim is to be submitted to, based on the permanent address or should it be billed to the Part B Mac Jurisdiction

How to Avoid Future Denials

  • Check eligibility on the Noridian Medicare Portal to verify the beneficiary’s permanent address on file with the Social Security Administration
  • Identify correct DME MAC Medicare contractor to process claim, based on beneficiary’s permanent address
  • Ensure claim is submitted to correct jurisdiction, either the DME MAC or the Part B Mac Jurisdiction
  • File claims to Jurisdiction where beneficiary’s permanent residence is listed with the Social Security Administration. If changes are required, the beneficiary must contact the Social Security Administration (800-772-1213)

 

Last Updated Dec 09 , 2023