Industry Note:
Hold Off On 56900 Claims Action
Published on Fri Apr 20, 2012
If you had ADR'd claims denied in error with reason code 56900 (not receiving medical records within 30 days), hold off on taking any action. "Any claims that were denied incorrectly for this reason will be reprocessed based on the documentation that was submitted by the provider," HHH MAC Palmetto GBA explains on its website. "A new ADR will not be generated, nor will the provider be asked to resubmit the documentation." Likewise, hold off on filing a redetermination. If medical reviewers find a problem, "the claim will be adjusted to reflect the appropriate denial reason code," Palmetto explains. "The provider will receive a Remittance Advice (RA) showing the denial reason and may follow the normal appeals process.
