Reason Code Narrative

Insufficient or incomplete records received- This is a RAC determination

Common Reason Code Errors

• Insufficient or incomplete records received.
• Incomplete progress notes (i.e., unsigned, undated, insufficient detail, etc.).
• Unauthenticated medical records (i.e., missing provider signature, illegible signatures without a signature log or attestation to identify signer, electronic signature without the electronic record protocol that documents the process for electronic signatures.
• No documentation of intent to order services and procedures (i.e., incomplete or missing signed order or progress note describing intent for services to be provided).

Common Reason Code Corrections

• Review your Recovery Auditor Contractor (RAC) findings letter and respond to medical records request timely.
• Review National Coverage Determination (NCD) and the Local Coverage Determination (LCD) as applicable.
• A redetermination may be submitted if provider feels that sending in documentation will support need for service(s). The redetermination should include:
  • All applicable supporting medical documentation
  • Corrected UB-04 claim form
• Direct Data Entry (DDE) users can view remarks section for additional clarification.

Resources

• Remittance Advice Remark Codes
• Welcome to RAC Info! (cotiviti.com) -Review the ‘New Issues’ section.