Reason Code C5460 - JE Part A
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- Advance Beneficiary Notice of Noncoverage (ABN)
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- Drugs, Biologicals and Injections
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- Wound Care
Reason Code C5460
Reason Code Narrative
ITEM OR SERVICE IS SUBJECT TO PRIOR AUTHORIZATION AND A NON-AFFIRMED DECISION IS PRESENT ON THE PRAU AUXILLARY FILE.
Common Reason Code Errors
- Non-affirmed prior authorization request on file for service billed on the claim.
Common Reason Code Corrections
- Auto denial
- A redetermination request may be submitted if facility feels that sending additional documentation will support need for service(s) provided
- Redetermination should include:
- All applicable supporting medical documentation
- Corrected UB-04 form
- Redetermination should include:
Resources
Last Updated Tue, 30 Aug 2022 13:37:51 +0000