Reason Code 56900

Reason Code Narrative

THIS CLAIM IS BEING DENIED BECAUSE THE PROVIDER DID NOT RETURN THE MEDICAL RECORDS WITHIN 45 DAYS. IN ORDER TO BE CONSIDERED FOR REIMBURSEMENT, PROVIDERS MUST ASK FOR AN APPEAL OR REDETERMINATION FOR THIS CLAIM. APPEALS MUST BE SUBMITTED TO MEDICARE WITHIN 120 DAYS FROM THE DATE OF DENIAL. 9.1- THE INFORMATION WE REQUESTED WAS NOT RECEIVED. PROVIDER LIABLE.

Common Reason Code Errors

  • Medical records were not received by reviewing entity that requested Additional Documentation Request (ADR) within 45 days
    • Reviewing entities can include
      • The Medicare Administrative Contractor (MAC)
      • The Recovery Auditor (RA)
      • The Unified Program Integrity Contractor (UPIC)

Common Reason Code Corrections

  • If ADR was not received by entity, a Redetermination request may be submitted to Noridian. In some cases, these will be handled as a reopening rather than a Redetermination. Request should include:
    • All applicable supporting medical documentation
    • Corrected UB-04 form
    • In some cases, timing can be an issue. For example, if you respond to Recovery Auditor on day 45 and they do not inform the MAC that they have received documents until day 46, claim may have denied 56900 incorrectly. If you have received a results letter from entity and claim is denied, contact Provider Contact Center (PCC).

Providers with Direct Data Entry (DDE) access should check ADR locations frequently. (SB6001). Providers who receive hard copy ADR requests should work within their facility to ensure that letters are reviewed and responded to timely. To avoid 56900 denials, providers are reminded to verify and respond to entity that is requesting ADR.

Resources

View reason code list, return to Reason Code Guidance page

 

Last Updated Jun 26, 2018