Reason Code 109 | Remark Code N418

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: N418 Misrouted claim. See the payer's claim submission instructions.

 

Common Reasons for Denial

  • Claim was billed to incorrect contractor
  • For date of service submitted, beneficiary was enrolled in a Medicare Health Maintenance Organization (HMO)

Next Step

  • View Expanded Denial Details for HMO Denial Details through claim status on the Noridian Medicare Portal for claim, to determine Plan Name and Address and Plan ID in order to bill claim to HMO
    • To update the status of the HMO, the beneficiary or legal representative must contact the plan.
  • If Medicare HMO record has been updated for date of service submitted, a self service reopening in the Noridian Medicare Portal may be conducted. Eligibility can be viewed in the Noridian Medicare Portal for date of service billed
  • 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.

How to Avoid Future Denials

 

Last Updated Dec 09 , 2023