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Reason Code Search and Resolution

Disclaimer: This is not a complete listing of reason codes.

The Reason Code Search and Resolution tool allows you to view a reason code description and determine how to prevent/resolve the edit. You may search by reason code or keyword. All records matching your search criteria will be returned for your review. You may also select "Show all Reason Codes" to view the complete list.

If the reason code you enter does not display here, you may access any reason code description in the Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE) Reason Codes Inquiry Menu (Option 17). For additional information, please reference the FISS DDE User Manual.

We also welcome your feedback. Requests to add or clarify information provided in this tool may be submitted to: J15_PartA_Education@cgsadmin.com.

Reason Code

Reason Code U5200

Description:

The CMS records indicate that the beneficiary is not entitled to Medicare coverage for this type of services billed on the claim. Therefore, no Medicare payment can be made.

Resolution:

Check/Verify Entitlement by Calling the Interactive Voice Response (IVR) at 866.289.6501 (Option 1), using HETS, or Direct Data Entry (DDE), using the ELGA/HIQA Option.

For more information about HETS and how to obtain access to the system, refer to the CMS HETS Help web pageExternal website on the CMS website.

For Information on obtaining eligibility in DDE, refer to the Checking Beneficiary EligibilityExternal PDFChapter of the DDE User Manual/FISS Reference Guide.

Note: The DDE Option will be discontinued in the future.

Resubmit claim with correct eligibility information.

Disclaimer: CGS' online tools and calculators are informational and educational tools only, designed to assist suppliers and providers in submitting claims correctly. CGS makes no guarantee that this resource will result in Medicare reimbursement for services provided. Although we've made every reasonable effort to provide effective resources, CGS is not responsible for the consequences of any decisions or actions taken in reliance upon or as a result of the information that these tools provide. CGS is not responsible for any human or mechanical errors or omissions.

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