Action on medicare Denial for provider not eligible
Medicare reason code of denial
CO-B7: This provider was not certified/eligible to be paid for this procedure/service on this date of service.
CO-38: Services not provided or authorized by designated (network/primary care) providers.
Action on Denial
Services were denied because the date of service on the claim is prior to the effective date or after the termination date of the provider number submitted on the claim.
1: The provider should verify the correct date of service appears on the remittance advice. If the date of service on the remittance advice is not correct, the procedures for having errors corrected should be followed.
2: If the correct date of service appears on the remittance advice, there may be an issue with the effective date and/or termination date of the provider’s Medicare billing number.
Sometime it is necessary to contact Provider Enrollment.
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Hi,
ReplyDeleteWe have received denial from Medicare stating that " CO-B7: This provider was not certified/eligible to be paid for this procedure/service on this date of service", Even submitted the claim within provider number `effective date.
Note: We have submitted the claim with multiple service (many CPT's) but claim paid partially and remaining CPT denied as mentioned above.
Denied CPT is G0431. Kindly suggest me the next course of action....
My email id: prabu.m110@gmail.com and phillip@healthquist.com
Thanks
Prabu