Remark code M117 indicates that the service or item billed is not covered under the patient's health plan unless the claim for it is submitted electronically. This means that if a paper claim is submitted for this service or item, it will be denied, and reimbursement will not be provided. To receive payment, the healthcare provider must resubmit the claim through an approved electronic submission process.
Common causes of code M117 are:
1. The claim was submitted using a paper form instead of the required electronic submission format.
2. The provider is not enrolled in the electronic data interchange (EDI) system that is mandated by the payer for claim submissions.
3. The payer's policies or the provider's contract specifies that certain services or claims must be submitted electronically to be considered for payment.
4. The claim may have been initially submitted electronically but was rejected due to errors, and the subsequent resubmission was mistakenly done via paper claim.
5. There may be a misunderstanding or lack of awareness on the provider's part regarding the payer's requirements for electronic claim submission.
6. Technical issues or system errors could have resulted in the claim being printed and sent as a paper claim instead of being transmitted electronically.
7. The provider may have defaulted to paper claims for certain types of services or under specific circumstances, not realizing that the payer requires electronic submission for all claims.
Ways to mitigate code M117 include transitioning to an electronic health record (EHR) system that supports electronic claims submission if you haven't already done so. Ensure that your billing staff is trained on the electronic submission process and that they are aware of the payer's requirements for electronic claims. Regularly update your EHR and billing software to comply with the latest electronic data interchange (EDI) standards and payer specifications. Additionally, conduct periodic audits to confirm that all claims are being submitted electronically and that none are being sent via outdated methods, such as paper forms or fax. Implementing a system to track claim submission methods can also help in identifying and correcting any issues promptly.
The steps to address code M117 involve transitioning from paper-based claims to an electronic submission process. Begin by ensuring that your billing software is up to date and capable of submitting claims electronically to the payer. Train your billing staff on the electronic submission process, including how to properly format claims to meet the payer's requirements. Verify that all necessary provider enrollment forms for electronic billing have been completed and submitted to the payer. Once these steps are in place, resubmit the denied claim electronically, and monitor the claim's status to ensure it is processed correctly. Additionally, consider converting all paper claim submissions to electronic to prevent future occurrences of this issue.