Tips to prevent RUC CO 24
This reason code is received when a claim is submitted to Medicare, and the beneficiary is enrolled in a Medicare Advantage plan or is covered under a capitation agreement. Charges are covered under a capitation agreement / managed care plan.
Medicare Advantage (MA):
- If a Medicare beneficiary enrolls in an MA plan, the MA plan replaces the beneficiary’s original Medicare plan.
- Medicare claims must be submitted to the MA plan.
- If a claim is submitted to Medicare, it will be returned as an unprocessable claim, and the remittance advice (RA) will indicate CARC CO 24.
- Obtain eligibility and benefit information prior to rendering services.
- Ask your patient if he / she has recently enrolled in any new health insurance plans.
- Request to see a copy of all of the patient’s health insurance cards.
- Always remember to check beneficiary eligibility prior to submitting claims to Medicare.
- Click here for ways to verify beneficiary eligibility prior to submitting claims to First Coast.
- Review SPOT FAQs to see how to verify eligibility and access corresponding benefits information on one of the most popular features of the SPOT.
- If the beneficiary's record with CMS is updated to reflect that he / she was not enrolled in an MA plan on the date(s) of service in question, resubmit the claim to First Coast.
- Claims that are returned as unprocessable cannot be appealed.
End-stage renal disease (ESRD) capitation agreement:
- Prior to seeing a patient for ESRD-related dialysis, verify eligibility. If the patient is covered under a capitation agreement, contact the capitation provider before rendering the service.
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