Remark code MA15 is an alert indicating that your claim has been divided to expedite processing. You will be notified separately about the status of the other services that were included in your claim.
Common causes of code MA15 are:
1. The claim contains multiple services that require different handling processes, and the payer has decided to process them separately to avoid delays.
2. Certain services on the claim may need additional information or documentation, prompting the payer to separate them from the rest of the claim to continue processing the other services.
3. The claim includes services that are subject to different payment rules or coverage criteria, necessitating individual attention and separate adjudication.
4. The services reported on the claim may involve different providers or locations, which could require distinct processing paths within the payer's system.
5. The claim may include a mix of services, some of which are standard and others that are non-standard or less common, leading to a separation to ensure proper handling of each service type.
6. There may be a need for coordination of benefits if the patient has multiple insurance plans, causing the payer to split the claim to address the primary and secondary payer responsibilities separately.
Ways to mitigate code MA15 include implementing a robust tracking system for claim submissions to ensure that each claim is monitored individually. This can help in identifying when claims are separated and allow for prompt follow-up.
Additionally, it's important to review the services reported on each claim to verify that they are grouped correctly according to payer guidelines and that there are no overlapping services that could trigger separation.
Regular training for billing staff on proper claim submission procedures can also reduce the likelihood of claims being separated to expedite handling.
Finally, maintaining open communication with payers can help clarify any specific requirements they may have for processing claims in a consolidated manner.
The steps to address code MA15 involve a few key actions. First, monitor your billing system for the additional notice regarding the separated services. This will provide details on the handling of the remaining items on the claim. Next, ensure that your accounts receivable team is aware of the separation so they can track and reconcile the payments and notices accordingly. It's also important to review the initial payment against the services paid to verify that the separation was appropriate and that the payment amount is correct for the services processed. If there are discrepancies or if the separate notice is not received in a timely manner, reach out to the payer for clarification. Lastly, document all communications and follow-ups regarding the separated claim to maintain a clear audit trail.