Outpatient Facility Coding Alert - 2020 Issue 11
Reader Questions: File New Claim if ‘Unprocessable’
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Article Overview
This article addresses a Medicare billing and claims-processing question about unprocessable claims and whether they can be appealed. It explains the distinction between rejected and denied claims, notes the role of the CMS Internet-Only Manual, and discusses a remittance advice remark code that signals the claim was not processed. It is useful for billing staff, coders, and claims follow-up teams who need to understand general claim status handling and resubmission workflow.
Why This Topic Matters
Understanding whether a claim was rejected or denied affects how a practice responds, including whether appeal rights exist and whether the claim must be corrected and resubmitted. The article helps revenue cycle staff interpret claim status communications more accurately.
What You Will Learn
- How unprocessable claims are generally treated in Medicare claims handling
- How rejection differs from denial in the claims process
- What general follow-up is appropriate after an unprocessable claim
- How remittance advice remark information can indicate claim status
Who Should Read This
- Medical billers
- Medical coders
- Revenue cycle staff
- Claims follow-up staff
- Practice managers
Codes Discussed
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