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

Article Overview

This article addresses a Medicare claims handling question about unprocessable claims and whether they can be appealed. It is aimed at billing, coding, and revenue cycle staff who need to understand the difference between unprocessable, rejected, and denied claims, and the general implications for claim follow-up and resubmission. The discussion references Medicare Administrative Contractors, the CMS Internet-Only Manual, and a remittance advice remark code used to indicate the situation.