Reason Code 55405 - JF Part A
Reason Code 55405
Reason Code Narrative
THE INFORMATION PROVIDED DOES NOT SUPPORT THE NEED FOR THIS SERVICE OR ITEM. NOT MEDICALLY NECESSARY.
Common Reason Code Errors
- Information received from Additional Document Request (ADR) does not support the medical need for service(s) provided.
Common Reason Code Corrections
- A Redetermination request may be submitted if the provider 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
Direct Data Entry (DDE) users can view remarks section for additional clarification.
Resource
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Last Updated Fri, 30 Dec 2022 18:59:57 +0000