Reason Code 197 | Remark Code N210 - JA DME

Common Reasons for Denial

• Prior authorization 14-byte Unique Tracking Number (UTN) was not appended to claim
• Special modifier to bypass the prior authorization process was not appended to claim line. This HCPCS code requires prior authorization

Next Steps

• Correct claim and rebill with the 14-byte UTN provided within the affirmative decision letter
  • If billing on CMS-1500 claim form, include UTN in Item 23
  • If billing electronically, include UTN in loop 2300 REF02 (REF01 = G1) or loop 2400 REF02 (REF01 = G1)
• If prior authorization is being bypassed, in certain situations, special modifiers are required to be appended to the claim. Please refer to Documentation and Modifier Requirements to Bypass Prior Authorization for those special modifiers
• If Advanced Beneficiary Notice of Noncoverage (ABN) was obtained because the beneficiary did not meet coverage criteria, or to bill a secondary insurance, and a non-affirmative prior authorization was obtained, submit a redetermination with all relevant supporting documentation. Noridian encourages Redeterminations/Appeals be submitted using the Noridian Medicare Portal

How to Avoid Future Denials

• Obtain prior authorization for item, prior to delivery
• Ensure to append 14-byte UTN provided within the affirmative decision letter to the claim
• If prior authorization is being bypassed, ensure the special modifiers required are appended to the claim line