Claim Submission Errors - CGS Medicare

Specialty ManualClaiM Submission ErrorSReturn Unprocessable ClaimsThis editing process returns paper and electronic claims to the provider as unprocessable if the Claim contains incomplete or invalid information. no appeal rights are afforded to these claims, or portion of these claims, because no initial determination can be Does Return as Unprocesssable Mean?returning a Claim as unprocessable does not mean CGS will physically return every Claim you submit with incomplete or invalid information. The term return as unprocessable is used to refer to the many processes utilized by CGS for notifying you that your Claim cannot be processed, and it must be corrected and resubmitted.

Claim Submission Errors Most of the following claim submission errors will have a Group/reason Code Co-16 (Claim/ Service lacks information needed for adjudication). When you receive a Group/reason Code Co-16, it will be accompanied by either a remarks Code or Moa Code identifying the missing/invalid information needed to process the claim.

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