Rejection CO 140, MA 61, CO 96, M117, N286 & N 234

Denial message code CO 140 ma 61

• Patient/insured health identification number and name do not match (140)
• Missing/incomplete/invalid social security number or health insurance claim number (61)

Reason for denial

• Claim was filed for a patient whose Medicare number does not match the SSA records and CWF

How to resolve and avoid future denials

• Review the patient’s file to locate a copy of the Medicare card. If copy has not be obtained:

* Contact the patient for the information

* Call the referring/ordering physician to obtain the information

• File a new claim with the correct name and Health Insurance Claim Number (HIC) as listed on the Medicare card

Denial message co 96 and M117

• Non-covered charge(s) (96)
• Not covered unless submitted via electronic claim (117)

Reason for denial

• Claims were received in hard copy format

How to resolve and avoid future denials

• Submit claims electronically in the HIPAA complaint 837 format
• If you must submit hard copy claims, contact EDI Technology Support Center to appeal your filing status
• EDI Technology Support – 1-866-749- 4301

Denial message CO 16 AND N286

• Claim/service lacks information which is needed of adjudication (16)
• Missing/invalid/incomplete referring provider primary identifier (286)

Reason for denial

• Claim was filed with a invalid or missing NPI in Item 17B of CMS 1500 Claim Form

How to resolve and avoid future denials

• Refile the claim with the valid referring provider NPI in Item 17B of the CMS 1500 Claim Form

Denial message co 16 N234

• Claim/service lacks information needed for adjudication (16)
• Missing/incomplete/invalid last seen visit date (234)

Reason for denial

• Claim was not submitted with a 6-digit or 8-digit date patient was last seen by their attending physician

How to resolve and avoid future denials

• Routine foot care
*  Item 19 of CMS 1500 claim form
• Include a 6-digit (mm/dd/yy) or an 8-digit (mm/dd/yyyy) date patient was last seen by his/her attending physician
• Include the NPI of the patient’s attending physician

Posted in: Denial and action