Reason Code 7NDOC
Reason Code Narrative
RAC COMPLEX REVIEW CMS DOCUMENTATION GUIDELINES NOT FOLLOWED.
Common Reason Code Errors
- Recovery Auditor (RA) has determined based on information received from Additional Document Request (ADR) that CMS guidelines for documentation were not followed on claim
Common Reason Code Corrections
- A Redetermination may be submitted if provider feels that sending additional documentation will support need for service(s) provided and they do not agree with RA decision. Request should include:
- All applicable supporting medical documentation
- Corrected UB-04 form
- If agree with RA decision, providers can submit Part B claims for reasonable and necessary Part A hospital claim denials. Also known as A/B rebilling.
Direct Data Entry (DDE) users can view remarks section for additional clarification.
- CMS Internet Only Manual (IOM) Medicare Claims Processing Manual, Publication 100-04, Chapter 4, Section 240.1
- Remittance Advice Remark Code List
View reason code list, return to Reason Code Guidance page.
Last Updated May 22, 2018