M25 (96)    REMITTANCE REMARK (161.93)

Name Value
CODE M25
STATUS EFFECTIVE DATE
  • 2003-06-01 00:00:00
    STATUS:   ACTIVE
    FEE USE:   APPLICABLE
DESCRIPTION EFFECTIVE DATE
  • DESCRIPTION:   
    The information furnished does not substantiate the need for this level 
    excess of any deductible and coinsurance amounts. We will recover the 
    reimbursement from you as an overpayment
    of service. If you believe the service should have been fully covered as 
    billed, or if you did not know and could not reasonably have been 
    expected to know that we would not pay for this level of service, or if 
    you notified the patient in writing in advance that we would not pay for 
    this level of service and he/she agreed in writing to pay, ask us to 
    review your claim within 120 days of the date of this notice. If you do 
    not request an appeal, we will, upon application from the patient, 
    reimburse him/her for the amount you have collected from him/her in