Reason Code 151 | Remark Code N115

Code Description
Reason Code: 151 Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.
Remark Code: N115 This decision was based on a Local Coverage Determination (LCD). An LCD provides a guide to assist in determining whether a particular item or service is covered. A copy of this policy is available at http://www.cms.gov/mcd, or if you do not have web access, you may contact the contractor to request a copy of the LCD.

 

Common Reasons for Denial

  • There is a date span overlap or overutilization based on related LCD.

Next Step

  • To adjust date span based on medical records available to supplier, a telephone reopening can be conducted
  • A Redetermination request may be submitted with all relevant supporting documentation. Review applicable Local Coverage Determination (LCD), LCD Policy Article, and documentation checklists prior to submitting request. Noridian encourages Redeterminations be submitted using the Noridian Medicare Portal

How to Avoid Future Denials

  • To avoid overlap, review previous claim submissions and date spans
  • For frequency guidelines, refer to applicable LCD and Policy Article
  • Prior to providing equipment, an Advance Beneficiary Notice of Noncoverage (ABN) may be obtained for items a supplier knows a beneficiary does not qualify for
  • To verify if beneficiary has/has not had a same or similar item in the past, suppliers may call Noridian Interactive Voice Response (IVR) or use the Noridian Medicare Portal

 

Last Updated Jun 25, 2018