Incomplete or Invalid Claim Information

Medicare remark: your claim contains incomplete and/or invalid information. Medicare cannot process until missing or incorrect data is corrected.

What This Means in Behavioral Health

Medicare Advantage and traditional Medicare BH claims—IOP G2086–G2088, PHP G0410/G0411, and hospital outpatient detox—receive MA130 when condition codes, revenue codes, or certification dates are wrong. Medicare edits are unforgiving on institutional UB-04 fields.

Root Causes

• Missing condition code 92 on Medicare HOPD IOP claims
• Incorrect revenue code for PHP or IOP institutional billing
• Attending physician NPI not enrolled with Medicare MAC
• Certification/recertification dates missing on PHP claims
• Occurrence span or code invalid for Medicare billing period

Prevention Tips

• Maintain Medicare BH crosswalk separate from commercial per diem paths
• Validate G2086–G2088 and revenue code 0905 on IOP before submit
• Track PHP recertification on day 18 and 30-day intervals for Medicare patients
• Confirm facility and practitioner Medicare enrollment before first claim