Author Topic: Claim is denied for CO-16  (Read 185 times)

Adnare01

  • Newbie
  • *
  • Posts: 17
Claim is denied for CO-16
« on: September 21, 2017, 06:02:03 AM »
Hello,

Medicare has denied a bunch of claims with CO-16 with remark codes MA125 and M136. and when i check the same claim at Medicare portal, it's paid there. I have no clue what is going on. Talked CSR at Medicare as well and they said the claim is denied.

Looking forward to get a resolution.

Regards,
Tayyab

nanap

  • Newbie
  • *
  • Posts: 12
Re: Claim is denied for CO-16
« Reply #1 on: September 21, 2017, 07:42:41 AM »
Well the Co16 means info is missing, The MA125 states paid in full - but does not necessarily mean a payment was made. and the M136 means Missing/incomplete/invalid indication that the service was supervised or evaluated by a physician.

I would call Medicare and ask them what specific info is missing. but my guess would be that a modifier is missing relating to the M136 denial

Adnare01

  • Newbie
  • *
  • Posts: 17
Re: Claim is denied for CO-16
« Reply #2 on: September 21, 2017, 08:06:01 AM »
Thanks for the response, I did call Medicare and they said they dont know what is missing. I am in dilemma that it is actually a denial or a payment

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4761
    • Solutions Medical Billing
Re: Claim is denied for CO-16
« Reply #3 on: September 21, 2017, 09:56:06 AM »
I would call back.  You must have gotten a bum rep.  They have all of the information in front of them.  They may tell you that you have to refer to the EOB but you just need to say that you are looking at the EOB but you need clarification.

Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

rballinger1

  • Newbie
  • *
  • Posts: 8
Re: Claim is denied for CO-16
« Reply #4 on: November 13, 2017, 10:31:32 PM »
What type of provider render the services?  The only time I have ever seen the MA136 used is when the supervising physician was not properly identified in Box 17.

The qualifier DQ should be listed along with the supervising physicians name and NPI #.  If the rendering provider does not require a supervising physician you might consider reviewing Box 17 to see if the DQ modifier was entered in error.  If you must contact Medicare about the claim, I would ask the representative to review Box 17 and provide you with the qualifier, provider's name and NPI appearing in their system.

I understand your frustration, it is becoming more difficult to get questions answered when calling Medicare.