A DME MAC receives a Paper Claim with Items or Services that are in Another DME MAC's Payment Jurisdiction (Rev. 2474, Issued: 05-18-12)

by  Find-A-Code
July 13th, 2015

When a DME MAC receives a claim submitted on the Form CMS-1500 for Medicare payment that should be processed by a DME MAC but was sent to the wrong DME MAC, the claim shall be returned as unprocessable.

Use the following messages:

CARC 109 – Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor.

RARC N104 - This claim/service is not payable under our claims jurisdiction area. You can identify the correct Medicare contractor to process this claim/service through the CMS Web site at www.cms.gov.

RARC 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. DME MACs shall continue to follow existing procedures for misdirected beneficiarysubmitted claims and electronic claims.

Pub 100-04 Medicare Claims Processing Manual

References:

• Pub 100-04 Medicare Claims Processing Manual