Steps to prevent reject reason code 36428
You can refer to Part A reason code lookup for a description associated with the Medicare Part A reason code. Simply enter a valid reason code into the box and click the submit button.
When submitting a claim for mammography screening services make sure the Food & Drug Administration (FDA) certification records are up to date, and the mammography services are within the scope of the FDA certificate on file.
There are two types of mammography services:
- Computer aided detection or film
- Digital
Refer to the CMS Medicare Learning Network (MLN) Preventive Services resource for coding and billing information.
Ensure your FDA certification is for the "type" of mammography service you're providing, and that the service is within the dates covered by the certificate.
- If your certification has expired, it must be updated prior to providing and billing mammography services
- Certification information may be updated with First Coast, via mail or fax:
First Coast Service Options
FDA Certification
P.O. Box 3411
Mechanicsburg, PA 10755-1825
or
Fax: 904-361-0737
Please allow at least seven business days for certification data to be updated.
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Submit claim adjustments for all claims that rejected with reason code 36428
- Go to Adjust or resubmit claim rejects for guidance on when to adjust a rejected claim
Reference
- CMS IOM Pub. 100-04 Medicare Claims Processing Manual, Chapter 18 preventive and screening services