Reason Code Narrative

Documentation does not support the medical necessity of the service billed.

Common Reason Code Errors

• Documentation does not support medical necessity of service

Common Reason Code Corrections

• Review your Recovery Audit Contractor (RAC) findings letter compared with the documents submitted to the RAC for review.
• A Redetermination may be submitted if provider feels that sending in additional documentation will support need for service(s). The redetermination should include:
  • All applicable supporting medical documentation
  • Corrected UB-04 claim form
• Review National Coverage Determination (NCD) and the Local Coverage Determination (LCD) as applicable.
• Direct Data Entry (DDE) users can view remarks section for additional clarification.

Resources

• Remittance Advice Remark Code List