Many providers are experiencing strange denials on their Medicare DME claims and when they call to check on them, they are being told to call the EDI department - even if they aren't submitting the claims electronically. Seems strange, but it's actually accurate.
The problem begins there. The customer service people with Medicare DME do not explain why the denials are occurring very well and you end the call scratching your head still not sure how to get the claims paid.
If they would just tell you in plain English what the problem was and how to fix it, it wouldn't be so bad. Well after my staff made several phone calls I finally picked up the phone myself and made a call to Medicare DME Region A. I finally figured out the problem after a hunch I had which was a complete miracle that I could piece this together. It certainly was not because they were explaining it well.
The problem is that the provider's national supplier number must be linked to the NPI number. This can be done fairly simply by going to the NPI enumerator web site, logging in, and adding the supplier number as one of the identifiers. It's a simple enough solution.
If you are receiving these strange denials I would recommend not even calling the DME carrier at first. I would check to see if you have your supplier number linked to your NPI number and if not, do so. If it already linked then you are having a different issue. Otherwise, once it is linked, just resubmit your claims!
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Is it illegal to Prebill Med A private coinsurance before Medicare pays the claim?
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