Article Detail - JF Part B
Top Denials and Solutions - Q4 2025
October, November and December of 2025
This article highlights the top five quarterly claim denials and their key solutions for Part B Jurisdiction F, along with the most common front‑end rejections and how to prevent them. It also summarizes frequent call center inquiries and recurring Medical Review errors to help identify patterns that lead to avoidable denials. These resources and best practices can be utilized to support accurate claim submission and reduce future denials.
Duplicate Claim or Service
(CO-97 and CO-B20, N111)
Allow 30 days from first submission before resubmitting.
Check claim status in Noridian Medicare Portal (NMP)
Invalid Credentials
(CO-B7, N570)
Confirm provider enrolled on date of service.
Verify correct Clinical Laboratory Improvement Amendment (CLIA) number submitted on claim
Medically Unlikely Edit (MUE)
(CO-151)
Review CMS MUE spreadsheet and Noridian MUE Lookup Tool
Medicare Advantage
(CO-24)
Verify patient’s eligibility in NMP and bill that managed care insurance
Missing/Incorrect Required Claim Information
(CO-16, M51/N56)
Submit new claim with corrected and/or complete information
Top Electronic Data Interchange (EDI) Front-End Rejections and Possible Solutions
National Provider Identifier (NPI) and/or Billing Provider’s Tax ID
Check Provider Enrollment, Chain, and Ownership System (PECOS) Rendering NPI number, and ensure NPI matches Tax ID
Diagnosis error for service(s) rendered
Review ICD-10 codes. If related to a policy, check coverage
Invalid HCPCS or CPT codes
Check current HCPCS or CPT book for valid codes and descriptions. Check Medicare fee schedule to verify validity
Invalid subscriber's contract or member number
Verify EDI submitter ID
Top Provider Call Center Inquiries and Solutions
Duplicate claims
Utilize NMP and Review CMS Medically Unlikely Edits (MUE) spreadsheet
Terminated Medicare Beneficiary Identifier (MBI) or Part B effective date
Utilize NMP
Medicare Secondary Payer (MSP)
Review NMP Eligibility for primary payer and utilize MSP webpage
National Correct Coding Initiative (NCCI) Procedure to Procedure Edits (PTP)
Utilize Noridian’s NCCI PTP Lookup Tool
Health Maintenance Organization (HMO)
Review NMP Eligibility before billing
