Tuesday, June 17, 2008

B7 (Provider Ineligible) Denials & NHIC/Medicare’s Option Code Project

ANCO member practices (especially group practices) may have received or may receive claims denials with denial code B7 (provider ineligible) due to provider identification (PTAN) number deactivation by the carrier.

The reason for these denials is that your physicians’ PTAN have been deactivated for non-use, OR are not attached to your group identification number, OR your group identification number is not linked to your physicians’ PTANs.

To avoid and resolve these denials you will need to submit Forms 855R and 855I (if the physicians have not updated their Medicare enrollment since 2003). Submit these forms immediately! These forms are available at

CMS 855R Application

CMS 855I Application

Please note that Form 855R does not have a place for reactivation. However, NHIC/Medicare advises providers to write “REACTIVATION” across the open space in section 1 on page 3 of the form.

Submit these forms to the following address using the Option Code Project (in order to expedite processing) cover sheet:

Northern California
Medicare Provider Certification
P.O. Box 2812
Chico, CA 95927-2812

For additional information, please contact NHIC/Medicare customer service at (877) 527-6613, option 3.

NHIC/Medicare is committed to processing clean applications submitted by July 1st with the Option Code Project cover sheet by August 1st.

OPTION CODE PROJECT COVER SHEET should contain the following text:

Place this page at the beginning of provider application(s) to assist with expediting.


Group ID Number: __________________

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