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Reason Code 16 | Remark Code M60 - JD DME

Reason Code 16 | Remark Code M60

Code Description
Reason Code: 16 Claim/service lacks information or has submission/billing error(s)
Remark Code: M60 Missing Certificate of Medical Necessity


Common Reasons for Denial

  • An initial Certificate of Medical Necessity (CMN) or DME Information Form (DIF) was not submitted with claim or on file with Noridian or
  • CMN is in denied status

Next Possible Steps

How to Avoid Future Denials

  • To verify a CMN or DIF is required, required for dates of service prior to January 1, 2023, refer to applicable Local Coverage Determination (LCD), LCD Policy Article
  • For proper claims processing, attach initial CMN or DIF to claim, required for dates of service prior to January 1, 2023
    • Supplier must submit initial CMN or DIF for item billed
  • If an initial CMN or DIF is posted to Common Working File (CWF) under another jurisdiction, include a comment on claim narrative
  • Ensure all the front end acknowledgement reports from the electronic transmission with CEDI are worked by supplier staff or clearinghouse, to ensure the CMN/DIF is put on file


Last Updated Fri, 24 Mar 2023 12:12:31 +0000