Durable Medical Equipment - Most Common Denial Reasons

See below for the most common denial reasons - durable medical equipment.

Error 0503 - Services on Claim and EOB Differ

Error: There is a discrepancy between the Explanation of Benefits (EOB) from the other insurer and the MassHealth claim, or in the other information from the primary insurer.

Resolution: Verify and correct the claim or EOB (as necessary) then resubmit the claim. Refer to the provider billing tips flyer, Correcting Error Code 053, located in the Billing Tips link under MassHealth Customer Service for Providers in MassHealth for Providers for assistance in correcting the issue.

Error 3003 - Procedure Code Requires PA

Error: The service code entered on the claim requires a prior-authorization (PA) number.

Resolution: Refer to the DME & Oxygen Payment and Coverage Guideline Tool where a list of all covered codes indicates those codes requiring a PA. You can request a PA electronically through MassHealth's Automated Prior- Authorization System (APAS). For information on APAS, call 1-866-378-3789.

Error 4240 - Procedure Must Be Billed Separately for Each Date of Service

Error: The service was billed for a date range, and not for a single date of service.

Resolution: Correct the claim by sending in each date of service for that procedure code on a different claim detail line.

Error 8028 - 8087 - DME Limit "XX" Units per Time Period

Error: The service was billed for more units than those allowed within a specific time period for the member.

Resolution: Verify number of units allowed for the service in the Provider Manual.


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