Claim Paid at Maximum Allowed Amount - JF Part B

Common Reasons for Message

Note: This is NOT a denial but a pay message.

• Item or service paid Medicare allowed amount
• Item or service paid to patient's deductible and/or coinsurance
• Item or services paid with partial units

Next Step

• Review claim status prior to submitting a Redetermination request, check Interactive Voice Response (IVR) or the Noridian Medicare Portal (NMP)
• Review to see if payment went towards patient's deductible
• Submit Appeal request - Items or services with this message have appeal rights
  • Redetermination request can be submitted with applicable supporting documentation
  • Noridian encourages submission of Redetermination requests using the Noridian Medicare Portal