tci ED Coding & Reimbursement Alert - 2021 Issue Q1

Reader Questions: Don’t Count on Appeals for Unprocessable Claims

Question: We received an “unprocessable” claim from our Medicare Administrative Contractor (MAC). Can we appeal this? Ohio Subscriber Answer: No, you can’t appeal an unprocessable claim because, technically, it was never filed. Another term for” unprocessable” is “rejected.” Rejected claims never enter the adjudication process as denials do. If a claim is deemed unprocessable, the reopening unit won’t be able to handle it. The CMS Internet-Only Manual describes an unprocessable claim as any claim with incomplete or missing required information, or any claim that contains complete and necessary information that proves invalid. Remark code:...

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