Article Detail - JD DME

Navigating Medicare claim denials at times can be frustrating. However, understanding common reasons for denial and how to address them can reduce denials and ensure timely reimbursement. A common reason for claim denials, along with steps to rectify the situation is below.

Incorrect Jurisdiction: Claims must be billed to the jurisdiction listed as the beneficiary’s permanent address on file with the Social Security Administration (SSA).

Next Step: Submit the claim to the correct jurisdiction indicated by the beneficiary’s permanent address on file with the SSA. Verification of this address can be done through the Noridian Medicare Portal.

How to Avoid Future Denials:

• Verify Permanent Address: Regularly check the beneficiary’s permanent address on file with the SSA using the Noridian Medicare Portal to ensure accuracy.
• Select Correct Medicare Contractor: Identify the correct DME Medicare contractor based on the beneficiary’s permanent address.
• Submit Claims to Correct Jurisdiction: Ensure that claims are submitted to the appropriate MAC, whether the DME MAC for DMEPOS items or the Part B MAC for physicians or other outpatient services. The beneficiary’s permanent address on file with the SSA should be listed as the address in line item 5 of the 1500 form or the appropriate electronic loop for an electronic claim, to ensure it is submitted and processed by the correct jurisdiction.
• Update Address if Necessary: If there are any changes to the beneficiary’s permanent residence, prompt action must be taken by the beneficiary by contacting the SSA to update the address.

By following these steps, suppliers can minimize the risk of claim denials, streamline the reimbursement process, and ensure that beneficiaries receive the care they need without unnecessary delays.