Unprocessable Claim Rejections Do Not Have Appeal Rights

Below is a screen print from page 121 of the Centers for Medicare & Medicaid Services (CMS) publication titled, "Understanding the Remittance Advice: A Guide for Medicare Providers, Physicians, Suppliers, and Billers"Adobe Portable Document Format. WPS Medicare frequently receives redetermination requests for Medicare claim rejections that have a Remittance Advice Remark Code (RARC) of MA130. The RARC MA130 states, "Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information."

In addition, to RARC MA130, the Remittance Advice will contain one or more additional messages detailing the specific reason for the rejection. Please verify your software is accessing all remarks and reason codes provided. Providers are also encouraged to obtain claim denial and claim rejection information using self-service technologies. This includes the Interactive Voice Response (IVR) System and the CMS Secure Net Access Portal (C-SNAP).

If after researching the additional remarks codes and using the self-service technology available, you do not understand the reason for the rejection, please Contact Us.

Unprocessable Claim Rejections Do Not Have Appeal Rights

Page Last Updated: Wednesday, 04-May-2011 11:12:15 CDT