[mkroper]

We are in Region C and have gotten about several CO184 Medicare denials that say, "The prescribing/ordering provider is not eligible to prescribe/order the service billed. This change to be effective 7/1/2010: Theprescribing/ordering provider is not eligible to prescribe/order the service billed. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."

Is anyone else getting this and why is it happening before the 07/06/10 PECOS deadline?

[KarenAMS]

We are also in Region C and received several of the CO184 Medicare denials today. Customer Service said they are prepay audits and need to send delivery ticket and medical documentation with a cover sheet to the redetermination fax line.

[KarenAMS]

Claims show they are still in process waiting for documentation.

[mkroper]

We were told that we needed to send a letter from the physicians on their letterhead stating that they want to continue to write scrips for specific equipment. Cigna never mentioned medical records to us. Our claims can't be pre-pay audits, because one is for a wheelchair in MS.

[KarenAMS]

Spoke to a different Medicare rep and was told that they are not prepay audits. They are in fact denials that are asking for documentation for the claim - delivery ticket, script, cmn, etc.. Send to redetermination fax line. She did not mention any specific information that we need to get on the physician other than the prescription that he wrote for the item being billed. All of our items are also rental items in the middle of the billing periods. I wish they would get their stories right, because now I am more confused than ever.

[mkroper]

Thanks Karen,
We are now being told that also. That denial code is so misleading!! Wonder why they didn't use one that said something about medical necessity!!

[misbell]

None of these answers can be right. We received 132 of them today. I was told that an edit was turned on at Medicare and this is happening in error.

[KarenAMS]

So maybe before sending in documentation, we should wait a day or two and then check back with customer service to see what they say then.

[mkroper]

We are hearing that it is now an error, too! We call every hour and get a different explanation. I think we are going to go with the error!!

[misbell]

Where did you hear that it was an error?