Claim Denials

Sift Denials Insight: NGS Medicare Denials

Post by
Sift Insights Team

A quick Intelligence Nugget for the week from the Sift Insights Team:

If your health system or hospital is in Medicare jurisdiction K (Upper Northeast) or 6 (IL, WI, MN), take a close look at your overturn performance for NGS Medicare remittances denied with 16-Lacks Info Needed For Adjudication denials and no accompanying RARC codes. 

For Sift client organizations in these jurisdictions, we are currently seeing 60-80% overturn frequency for CARC 16/No RARC claims. This presents an opportunity for your organization to speak with your NGS MAC representative about reducing these administrative payment delays. 

When analyzing your overturn frequency, pay particularly close attention to how often the following types of claims are being overturned:

  • DRG 885 claims
  • ED (045X) and PT (042X) claims

Want to know more? Drop our Insights Team a line a question at

Interested in a full Denials Assessment for your health system? Click here to see if your organization qualifies.

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