Part B Insider - 2020 Issue 11
Reader Questions: File New Claim if ‘Unprocessable’
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Article Overview
This reader Q&A covers Medicare claim workflow when a claim is returned as unprocessable or rejected, including the role of remittance advice remark codes and the distinction between claims that were not processed versus claims that were denied. It is relevant to billing staff, coders, and revenue cycle teams who need to understand Medicare administrative handling and basic claim resubmission pathways.
Why This Topic Matters
Understanding whether a Medicare claim was processed, rejected, or denied affects how a provider responds and whether appeal rights exist. The article helps readers recognize the administrative status of an unprocessable claim and the general next step of correcting and resubmitting it.
What You Will Learn
- How Medicare treats claims returned as unprocessable or rejected
- How remark codes on remittance advice relate to claim status
- Why some claims do not have appeal rights
- When a claim may need to be corrected and resubmitted
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle personnel
- Practice administrators
Codes Discussed
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