Common Reasons for Denial

• Item requires DIF or CMN
• Specific ICD-10 required
• KX modifier required
• Claim billed as upgrade and ABN was obtained. Beneficiary is liable

Next Step

• If a DIF or CMN is required, submit request to Redeterminations with required CMN or DIF
• If the remittance advice reason includes MA130, correct claim and rebill
• Request a self service reopening in the Noridian Medicare Portal if a clerical error occurred (missing or incorrect Diagnosis code)
• A Redetermination request may be submitted to add, change or remove the KX modifier or other specific complex modifiers. Include all required documentation for review 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
• Collect amount from beneficiary if not paid previously for upgrade, beneficiary liable

How to Avoid Future Denials

• Attach the required CMN or DIF that is required for HCPC that is being billed
• Verify that the diagnosis code is correct
• Verify the required modifiers are appended to the HCPC codes submitted. The Modifier Lookup Tool may be utilized to verify proper modifiers that may be appended to claim