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

  • If Medicare HMO record has been updated for date of service submitted, a telephone reopening can be conducted
  • A Redetermination request may be submitted with all relevant supporting documentation if HMO record has been updated for date of service submitted. 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

 

Last Updated Apr 18, 2018