Remark code M142 is an indication that the claim submitted lacks the necessary American Diabetes Association Certificate of Recognition, which is required for the services billed to be covered or reimbursed. This certificate demonstrates that certain standards of diabetes care have been met, and without it, the claim may be denied or require additional documentation before processing can continue. Providers should ensure that this certificate is obtained and appropriately attached to claims for services related to diabetes education or management.
Common causes of code M142 are typically related to the submission of claims for diabetes self-management training (DSMT) services. These causes may include:
1. The healthcare provider has not obtained or renewed the required American Diabetes Association (ADA) Certificate of Recognition for their DSMT program, which is necessary to demonstrate that the program meets the National Standards for Diabetes Self-Management Education and Support.
2. The claim was submitted without the appropriate documentation indicating that the provider's DSMT program is currently recognized by the ADA.
3. There may have been an administrative oversight or error in attaching the ADA Certificate of Recognition to the claim or in the claims processing system, leading to the rejection of the claim.
4. The certificate may have expired, and the provider did not realize it or failed to renew it in time, resulting in the denial of the claim.
5. The claim form may have been filled out incorrectly, omitting or misreporting the information related to the ADA recognition status.
6. The payer's records may not be up to date, and they may not have the current ADA Certificate of Recognition on file for the provider, even though the provider has obtained or renewed it.
7. The provider may have recently received ADA recognition for their DSMT program, but the information has not yet been communicated to or acknowledged by the payer.
Addressing these issues typically involves ensuring that the ADA Certificate of Recognition is current and properly documented, and that this information is accurately reflected in the claims submitted to payers.
Ways to mitigate code M142 include ensuring that your facility has obtained the American Diabetes Association Certificate of Recognition and that it is current. Regularly check the expiration date and set reminders to renew the certificate well in advance. Additionally, establish a protocol for including proof of this certification with all relevant billing submissions to avoid this issue. It's also important to train your billing staff to recognize which services require this certificate so that they can verify its presence before claims are submitted.
The steps to address code M142 involve verifying whether the American Diabetes Association Certificate of Recognition is indeed missing or if it was simply not submitted with the claim. If the certificate is missing, obtain the necessary documentation by reaching out to the appropriate department or individual within your organization who manages certifications. Once the certificate is located, resubmit the claim with the certificate attached. If the certificate was overlooked during the initial claim submission, attach the certificate to the claim and resubmit promptly. Ensure that all future claims for services requiring this certificate include it at the time of submission to prevent this issue from recurring.