Common Reasons for Denial

• Claim is missing a Certificate of Medical Necessity or DME Information Form (Required for dates of service prior to January 1, 2023 only).
• Claim is missing the KX modifier.
• This is not a service covered by Medicare.

Next Step

• If the remittance advice reason includes MA130, correct claim and rebill
• If CMN/DIF was submitted with claim, a redetermination request may be submitted with all relevant supporting documentation. Noridian encourages Redeterminations/Appeals be submitted using the Noridian Medicare Portal. Review applicable Local Coverage Determination (LCD), LCD Policy Article, and Documentation Checklists prior to submitting request.
• If the KX modifier was omitted by mistake, request a Redeterminations/Appeals to add, change, or remove the KX (the same is true for GA, GZ, GY modifiers). Be sure to include all the appropriate documentation.

How to Avoid Future Denials

• Check applicable Local Coverage Determination (LCD), LCD Policy Article, and Documentation Checklists prior to billing
• Utilize the Noridian Modifier Lookup Tool to ensure proper modifiers are included on claim