Wis. ForwardHealth Online Handbook, Hospice, Topic #688

Medicare disclaimer codes are used to ensure consistent reporting of common billing situations for dual eligibles. Refer to claim

instructions for Medicare disclaimer codes and their descriptions. The intentional misuse of Medicare disclaimer codes to obtain

inappropriate reimbursement from ForwardHealth constitutes fraud.

Medicare disclaimer codes identify the status and availability of Medicare benefits. The code allows a provider to be reimbursed

correctly by ForwardHealth when Medicare benefits exist or when, for some valid reason, the provider is unable to obtain such

benefits by reasonable means.

When submitting a claim for a covered service that was denied by Medicare, providers should resubmit the claim directly to

ForwardHealth using the appropriate Medicare disclaimer code on the claim or the Explanation of Medical Benefits form, as

applicable.

Code Description

M-7 Medicare disallowed or denied payment. This code applies when Medicare denies the claim for reasons related to policy

Documentation Requirements

Providers are required to prepare and maintain truthful, accurate, complete, legible, and concise documentation of efforts to bill

Medicare to substantiate Medicare disclaimer codes used on any claim, according to Wis. Admin. Code § DHS 106.02(9)(a).