decisionhealth Newsletters, Part B News - 2004 Issue 8 (August)
Errors or missing info mean your claim is not a ‘claim' yet
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Article Overview
This article reviews CMS guidance on Medicare claims that are held or returned because of minor errors, omissions, or missing information. It is aimed at billing and coding professionals who need to understand the general categories of claim problems CMS identifies, how carriers may communicate them, and why these issues matter for claim submission and follow-up workflow.
Why This Topic Matters
Knowing how Medicare distinguishes an unprocessable claim from other claim problems helps billing staff recognize when a submission needs correction, resubmission, or further clarification. The article also highlights why carrier notices and remark codes matter for tracking claim status and reducing avoidable delays.
What You Will Learn
- How CMS characterizes claims with missing, incomplete, invalid, required, or conditional information
- What types of carrier notices may be used when a claim is held or returned
- Why remark codes and payment indicators matter in claim follow-up workflows
- How billing offices may handle claim correction and resubmission at a high level
Who Should Read This
- Medical coders
- Billing staff
- Practice administrators
- Revenue cycle teams
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