Provider not certified denial - what need to be done

CO B7 Provider was not certified/eligible to be paid for this procedure/service on this date service

(THIS PHYSICIAN/SUPPLIER IS NOT ELIGIBLE TO RECEIVE PAYMENT)



Resources/tips for avoiding this denial

Services were denied because the date of service(s) on the claim is prior to the effective date or after the termination date of the Medicare enrollment of the billing provider who appears on the claim.



• Ensure to submit only claims for services during which the provider had active Medicare billing privileges.

• If services were provided prior to or after a provider's Medicare billing privileges were active, this denial will be received.



Tips to correct the denied claim

Verify the correct date of service(s) appears on your Medicare Remittance Advice (RA).

• If the date of service(s) on the RA is not correct, the procedures for correcting claims errors should be followed.

• Clerical error reopening requests to correct the date of service can be performed.

• If the date of service(s) is correct, there may be an issue with the effective or termination date of the provider’s Medicare billing number.