Electronic Claim Required: Denials

Published 10/09/2018

Denial Reason, Reason/Remark Code(s)

  • M117 — Not covered unless submitted via electronic claim
  • MA44 — Alert: No appeal rights. Adjudicative decision based on law.
  • 96 — Non-covered charge(s)
  • MA130 — Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information. 

Resolution/Resources

  • The Administrative Simplification Compliance Act (ASCA) requires claims to be submitted electronically to Medicare, with a few exceptions. See our Mandatory Electronic Submission of Medicare Claims article for more details.
  • If you received a "Review of Paper Claims Submission Practices" letter from Palmetto GBA Railroad Medicare requesting documentation that establishes you meet an exception to submit paper claims, you must return the letter with the requested documentation within the specified time frame
  • If you do not supply the requested documentation within the time frame or if you do not qualify for a waiver to submit paper claims, you are required to file electronic claims to Palmetto GBA Railroad Medicare 
  • If you have received a "Review of Paper Claims Submission Practices" letter from Railroad Medicare and have questions, please call our  Provider Contact Center at 888-355-9165, Monday through Friday from 8:30 a.m. to 4:30 p.m. for all time zones with the exception of PT, which receives service from 8 a.m. to 4 p.m. Choose option 5 for Customer Service, and then to speak to a representative, press 0.
  • If you have questions about billing electronically, including how to enroll or how to obtain free billing software, see our Electronic Data Interchange (EDI) resources or contact the EDI Technical Support Center
  • As an alternative to billing paper or electronic claims, registered eServices users can submit paperless eClaims through eService. You can participate in eServices if you have a signed electronic data interchange (EDI) Enrollment Agreement on file with Palmetto GBA. For more information, see the Access eServices section of our website.  

Resources

  • CMS MLN Matters article MM 3440, "Administrative Simplification Compliance Act (ASCA) Enforcement of Mandatory Electronic Submission of Medicare Claims" (PDF, 72 KB)
  • CMS EDI Web page including more information on ASCA requirements and exceptions