UPDATED: B7 Denials Regarding Accreditation; NAS Aware of Issue and Working with CMS on Solution

1. At the NSCAC meeting today it was announced by CMS that accreditation edits that were causing the B-7 denials have been removed.  The DME MACS will reprocess the denied claims as soon as possible


2. New claims being billed will not deny since the edits have been removed.

NAS is notifying DME suppliers that on 07/05/2011, an error in the supplier file information provided to our office by a different CMS contractor caused claims to deny as if a supplier was not accredited. NAS is able to identify the claims impacted by this and began suspending the claims instead of processing them for potentially incorrect denials on 07/15/2011. NAS is working on a daily basis with the NSC, other DME MACs, the claims processing system maintainer, and the CMS to implement a solution. 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. Instead, As the solution and necessary actions to correct the issue are determined, NAS will provide additional information to our supplier community.

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.

NAS and CMS are working to implement a solution that causes the least amount of work or burden for our supplier community.

Posted on July 15, 2011