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

Direct Data Entry (DDE) users can view remarks section for additional clarification.

Resource

• Remittance Advice Remark Code List

View reason code list, return to Reason Code Guidance page.