Reason Code 7R042

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.



Last Updated Oct 17 , 2022