Reason Code 109 | Remark Code N130

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: N130 Consult plan benefit documents/guidelines for information about restrictions for this service.

 

Common Reasons for Denial

  • Claim was submitted to incorrect contractor

Next Step

  • Resubmit claim to correct contractor
  • If beneficiary was not inpatient on date items were provided, 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
  • If wrong date of service was billed, suppliers may call telephone reopenings to correct it

How to Avoid Future Denials

 

Last Updated Apr 18, 2018