Regarding CO B-7 Denials

On July 26, VGM’s Peggy Walker attended the CGS, DME MAC Jurisdiction C, meeting regarding the Medicare CO-B7 denials.  Suppliers were given this denial code in error because of an edit that was turned on in early July.  The code indicated that the supplier was not certified or eligible to be paid for a procedure or service on the date of service.  

During the meeting, however, Mark Loey with the Provider Outreach Group made the following announcements:

CO B-7 issues have been identified –  edits have been turned off –  all denied incorrectly will be reprocessed when all issues have be resolved.

All issues have been identified, but not all have been resolved at the moment.

RAC audit  ARs cancelled this week and adjustments are being corrected on improper claims recoupment requests relating to Infusion and O & P audits.

 According to Peggy, CMS informed attendees at a meeting last week that the edits were removed and that everything was “okay.” However, some claims were still being denied as of last Thursday or Friday.

The following are messages from NHIC regarding the B7 denials:

July 18, 2011 — On 07/05/2011, an error in the supplier file information provided to the DME MACs caused claims to deny as if a supplier was not accredited. NHIC is working closely with the NSC, CMS, the system maintainer and the other DME MACs as we diligently work toward a quick resolution. NHIC is currently suspending the claims to avoid any additional unnecessary denials and confusion. NHIC will identify the impacted claims for our Jurisdiction and will initiate an adjustment for automatic correction of the denials. There will be no need for our supplier community to have to re-submit the claims. The remittance advice reason code and narrative that suppliers will see which identify this issue is provided for your convenience.

·    Remittance Advice Reason Code B7: This provider was not certified/eligible to be paid for this procedure/service on this date of service. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

At this time, we are asking suppliers to no longer contact our office if they are receiving a “B7” reason code denial on their remittance advices. As the solution and necessary actions to correct the issue are determined, NHIC will provide additional information to our supplier community.

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July 19, 2011 —All DME MACs were instructed by CMS to deactivate the edit causing the B7 denials. As of 7/19, claims should no longer be denying due to this issue. A date has not yet been received for the reactivation of this edit, which will occur once the permanent solution to this issue has been determined.

NHIC will be issuing an express adjustment process early next week to automatically correct those claims denied in error. It will not be necessary for our supplier community to re-submit or contact our office concerning the denials.

We apologize for any disruption this may have caused and appreciate your patience as we work to resolve this issue.

For more information, please contact Peggy Walker at [email protected]