DME MACs: We're Working on Accreditation Denial Problem

Citing an error in supplier file information that was provided to them, the DME MACs are saying they are aware that DME claims are being denied as if the suppliers who submitted the claims aren’t accredited.

Both NHIC Corp. (Jurisdiction A) and CGS (Jurisdiction C, formerly known as CIGNA) sent out bulletins on Monday saying they know about the errors and are working on a resolution.

"NHIC is working closely with the NSC (National Supplier Clearinghouse), CMS (Centers for Medicare & Medicaid Services), the system maintainer and the other DME MACs as we diligently work toward a quick resolution," NHIC said in its announcement. "NHIC is currently suspending the claims to avoid any additional unnecessary denials and confusion. NHIC will identify the impacted claims for our jurisdiction and will initiate an adjustment for automatic correction of the denials."

NHIC added that suppliers will not have to resubmit claims that were incorrectly denied due to this error. CGS similarly noted, "We will automatically adjust all claims that have denied in error."

Affected claims would show a B7 Remittance Advice Reason Code, which means "This provider was not certified/eligible to be paid for this procedure/service on this date of service." Claims also may have said that providers could not appeal the denial decision.

NHIC asked providers not to contact them regarding B7 claims.

"As the solution and necessary actions to correct the issue are determined, NHIC will provide additional information to our supplier community," the announcement said.

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at lwatanabe@1105media.com.

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