Reason Code 151 | Remark Code N115

Code Description
Reason Code: 151 Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.
Remark Code: N115 This decision was based on a Local Coverage Determination (LCD).

 

Common Reasons for Denial

  • Policy frequency limits may have been reached, per LCD
  • There is a date span overlap or overutilization based on related LCD.

Next Step

  • Review claim submitted for frequency limits listed in LCD and Policy Article and either adjust amounts because of supplier liable or appeal claim with documentation to support medical need
  • Review Medically Unlikely Edit (MUE) tool for maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service.
  • Ensure all questions on Certificate of Medical Necessity (CMN) are qualifying
  • To adjust date span based on medical records available to supplier, suppliers may do a self-service reopening in the Noridian Medicare Portal
  • 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 Thu, 14 Oct 2021 18:40:37 +0000