Remark code M45 indicates a claim has been rejected due to missing, incomplete, or invalid occurrence codes.
Remark code M45 indicates that the claim submitted has issues with the occurrence code(s) provided. This could mean that the necessary occurrence code(s) are missing, incomplete, or invalid. Occurrence codes are used to report significant events that are relevant to the claim and may affect payer processing. The healthcare provider will need to review the claim, correct the information regarding the occurrence code(s), and resubmit the claim for processing.
Common causes of code M45 are typically related to errors or omissions in the required occurrence codes on the claim form. These occurrence codes provide essential information about events that relate to the billing period and are necessary for the processing of a claim. The common causes may include:
1. The occurrence code was not included on the claim when it should have been, leading to a lack of necessary information for claim adjudication.
2. An incorrect occurrence code was entered, which does not match the event described or is not appropriate for the claim type or service billed.
3. The occurrence code was incomplete, possibly due to a missing digit or incomplete description, which prevents the payer from understanding the context of the claim.
4. The claim form may have outdated or expired occurrence codes that are no longer valid or accepted by the payer.
5. There may have been a clerical error or data entry mistake when inputting the occurrence codes into the billing system or onto the claim form.
6. The claim may lack supporting documentation that justifies the use of the occurrence code entered, leading to the code being considered invalid by the payer.
Addressing these issues typically involves reviewing the claim for accuracy, ensuring that all required occurrence codes are present, correct, and supported by the appropriate documentation.
Ways to mitigate code M45 include implementing a comprehensive review process to ensure that all necessary occurrence codes are captured accurately on claims before submission. This can be achieved by:
- Training staff on the importance of occurrence codes and the common reasons for code M45 denials.
- Utilizing a robust electronic health record (EHR) system that prompts for required fields and occurrence codes based on the type of service, date, and other claim details.
- Conducting regular audits of claim data to identify patterns that may lead to M45 errors and addressing these systematically.
- Establishing a checklist for billing staff to verify that all required occurrence codes are present and valid for each claim.
- Keeping up-to-date with payer-specific guidelines on occurrence codes to ensure compliance with varying requirements.
- Integrating claim scrubbing software that automatically checks for missing, incomplete, or invalid occurrence codes before claims are submitted.
- Setting up real-time alerts for billers when a claim is missing necessary information, including occurrence codes, to allow for immediate correction.
- Collaborating with clinical staff to ensure that the information needed for accurate occurrence code assignment is documented clearly and promptly in the patient's record.
The steps to address code M45 involve a thorough review of the claim to identify any missing, incomplete, or invalid occurrence codes. Begin by cross-referencing the claim with the patient's medical record to ensure that all relevant occurrence codes have been captured accurately. If any codes are missing, add the appropriate information based on the documented events related to the patient's treatment or admission. For incomplete or invalid codes, correct them according to the specific details of the patient's encounter. Once all corrections are made, resubmit the claim for processing. It's also advisable to implement a quality assurance check prior to initial claim submission to minimize the risk of this error in the future.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
