Skip to main content
Corporate

Reason Code Search and Resolution

Disclaimer: This is not a complete listing of reason codes. Other reason codes will be added.

This Reason Code Search and Resolution tool has been designed to aid Medicare providers in reviewing reason codes and how to resolve the edit or use them for determining if other action is needed. You may search this database by reason code or keyword. All records matching your search criteria will be returned for your review. If you are aware of a reason code not listed or a description and/or a resolution is not clear, please send your suggestion for reason code addition or update to J15_PARTA_Education@cgsadmin.com.

If you wish, you may also view the entire listing of reason codes, their descriptions, resolutions, and additional billing information by clicking on the "Show all Reason Codes" option.

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.

Search by:


26 Century Blvd Ste ST610, Nashville, TN 37214-3685 © CGS Administrators, LLC. All Rights Reserved