How to Navigate a Medicare System Limitation for Efficient Claim Submission

There is an ongoing issue with the Medicare processing system (VMS) denying accessories when more than nine line items are submitted. Due to a system limitation, when more than nine line items are submitted on one claim, the MAC processing system (VMS) splits the claim, and if the accessory codes are processed before the base item pays, the accessories will deny as CO 16 (additional information required). The system is looking for a base item paid before the accessories used on that base item can be allowed. Many providers (mostly complex rehab) are submitting the entire claims with more than nine lines and when/if the accessories process first and deny, they have to resubmit them once the base pays.

However, it takes resources and time to identify the denial then resubmit those denied lines for reprocessing. If there are more than nine lines on a claim, it would be more efficient to submit the base and the eight other codes that have the highest allowable then, once the base code posts to pay, submit another claim with the remaining codes. This should avoid a denial of the accessories and the need to resubmit those items.

Medicare is aware of this system limitation, and there is no schedule fix date at this time.

If you have any questions, please contact Dan Fedor at [email protected] or 570-499-8459.

Dan Fedor
VGM Group, Inc.
Proud Employee-Owner
O: 844-794-8459
C: 570-499-8459
E: mailto:[email protected]
F: 844-307-5729