Medicare Error Code 9602 | Claim Denial Issue Fix

Medicare Error Code 9602 generally refers to a claim denial or issue related to eligibility or benefit status, which could be affecting the processing of a claim.

The specifics of this error code are often tied to issues with the patient’s Medicare enrollment or coverage status at the time of the claim.

Common Causes of Medicare Error Code 9602:

1. Eligibility Issues:

   • The patient might not be eligible for coverage at the time of the claim due to various reasons (e.g., they haven’t met the eligibility requirements, or their coverage may have been terminated).

2. Incorrect or Missing Information:

   • The claim may contain incorrect or incomplete information about the patient, such as the Medicare number, dates of coverage, or date of birth.

3. Medicare Enrollment:

   • The patient might not have completed the proper Medicare enrollment process or may be in a pending enrollment status.

4. Secondary Insurance or Coordination of Benefits Issues:

   • If the patient has secondary insurance, the claim may have been incorrectly processed under the wrong insurance type or needs coordination between primary and secondary payers.

5. Part A or Part B Eligibility:

   • The claim could be incorrectly linked to the wrong part of Medicare (Part A or Part B), leading to an error if the patient’s specific coverage is not valid for that service.

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Steps to Resolve Error Code 9602:

1. Verify Eligibility

• Check Patient’s Medicare Eligibility: You can verify the patient’s eligibility status by accessing the Medicare Beneficiary Inquiry (MBI) tool or the Eligibility Transaction System (ETS) on the CMS (Centers for Medicare & Medicaid Services) website or by contacting Medicare.

• Medicare Beneficiary Information (MBI): Make sure the Medicare number and personal details are entered correctly on the claim.

2. Confirm Enrollment and Coverage

• Medicare Enrollment Status: If the patient’s eligibility is in question, confirm their Medicare enrollment status and ensure they have the correct coverage (Part A, Part B, or Part D) for the services rendered

• Special Enrollment Period (SEP): If they are newly eligible or enrolling due to a special event, check that the enrollment process was completed properly

3. Check for Coordination of Benefits (COB) Issues

• If the patient has secondary insurance or coverage from a different provider, ensure the Coordination of Benefits (COB) rules are followed. This may require contacting the insurance provider or the Medicare Coordination of Benefits Contractor (COBC) to clarify.

4. Re-submit the Claim:

• Once you’ve confirmed all details (eligibility, coverage, etc.), correct any errors in the claim and re-submit it. This might involve:

  • Correcting the Medicare number.

  • Updating the date of service or other key details.

  • Adding any missing documentation or proof of coverage.

5. Contact Medicare or CMS

• If you’ve verified the information and the error persists, you may need to contact Medicare customer support directly to resolve the issue. They can give you specific details about why the claim was denied and what action to take.

  • Call Medicare: 1-800-MEDICARE (1-800-633-4227)

  • You may need to provide claim numbers or other identifying information to help resolve the issue quickly.

6. Consult with a Medicare Specialist or Billing Expert

• If you’re unsure of the exact cause, consulting with a Medicare billing expert or your organization’s billing department can help clear up eligibility issues and ensure proper claim submission.

Tip: If the error is related to a secondary payer (like private insurance or Medicaid), be sure the claim is processed in the correct order, as Medicare needs to be billed first, and then the secondary insurance may cover the remaining balance.