[hsopcak]

Just recently I have started receiving PR38 (services not provided or authorized by designated 'network' providers) denials. Has anyone else ran into this and know what it is all about. I can't seem to find anything on the CMS website. We are not in a CBA.... Medicare is useless when you try to call them.

[DwayneThomas]

Often times, when the PR38 denial is received, it means that there has been a change in the status of the billing provider number and/or NPI and Medicare records are not up to date. Be sure to review any remark codes provided on the EOMB. In order to correct, you will need to contact your local carrier if billing Part B services or the National Supplier Clearinghouse for DME. If I may be of assistance, feel free to contact me.

Dwayne Thomas
Healthcare Management Solutions
866-505-8866 ext 149