How to Verify Claim Denial Resolutions Efficiently

Did you know the two most common Medicare denials are due to submitting duplicate claims or the patient’s eligibility not being verified? To assist providers with these denials, Noridian offers Denial Code Resolution page that lists common denials providers receive and how to resolve them without the need of making unnecessary phone calls to Noridian’s call center. Below are a few examples of common denials that can be resolved with this link.

Duplicate claims will normally contain one of the following remark codes:

  • N111: No appeal right except duplicate claim/service issue. This service was included in a claim that has been previously billed and adjudicated, or
  • OA-18: Exact duplicate claim/service

If a patient has a Medicare Advantage Plan/HMO plan, the following remark code will display on the remit:

  • CO-24: Charges are covered under a capitation agreement/managed care plan.

If patient is in a Skilled Nursing Facility (SNF) or inpatient hospital stay, the remit will usually contain the following remark codes:

  • CO-109: Claim/service not covered by this payer/contractor.
  • N193: Alert Specific federal/state/local program may cover this service.
  • N538: (appears on SNF denials only)-A facility is responsible for payment to outside providers.

Patients with a terminated Medicare Number, or who don’t have Medicare for the date of service in question, will contain one of the following remark codes:

  • N382: Missing/incomplete/invalid patient identifier.
  • PR31: Patient cannot be identified as our insured.

NOTE: effective February 5, 2024, Noridian representatives will no longer provide any information available on Noridian self-service tools. Noridian encourages providers to share this information with their staff.

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Last Updated Jan 24 , 2024