Reason Code 7R042 - JE Part A
Reason Code 7R042
Reason Code Narrative
Insufficient or incomplete records received- This is a RAC determination
Common Reason Code Errors
- Insufficient or incomplete records received.
- Incomplete progress notes (i.e., unsigned, undated, insufficient detail, etc.).
- Unauthenticated medical records (i.e., missing provider signature, illegible signatures without a signature log or attestation to identify signer, electronic signature without the electronic record protocol that documents the process for electronic signatures.
- No documentation of intent to order services and procedures (i.e., incomplete or missing signed order or progress note describing intent for services to be provided).
Common Reason Code Corrections
- Review your Recovery Auditor Contractor (RAC) findings letter and respond to medical records request timely.
- Review National Coverage Determination (NCD) and the Local Coverage Determination (LCD) as applicable.
- A redetermination may be submitted if provider feels that sending in documentation will support need for service(s). The redetermination should include:
- All applicable supporting medical documentation
- Corrected UB-04 claim form
- Direct Data Entry (DDE) users can view remarks section for additional clarification.
- Remittance Advice Remark Codes
- Welcome to RAC Info! (cotiviti.com) -Review the ‘New Issues’ section.
Last Updated Mon, 17 Oct 2022 19:19:55 +0000