Medicare Claims Require Line Level Information

When submitting professional and outpatient institutional claims electronically — with Medicare as the primary payer — providers need to include both claim level dollars and line level payment dollars. Effective December 1, 2023, electronic Medicare claims without line level dollar information will be rejected.

To ensure processing, these claim types must be submitted with line level Claim Adjustment Reason Code (CARC) dollars. Currently, Highmark is correcting Medicare claims with missing line level information; that practice will end on November 30, 2023.

Starting December 1, 2023, line level payment information must be included with the electronic Medicare claim. Submitted claims missing this information will be returned to the provider for correction and resubmission.

The line level information can be found on the Explanation of Benefits sent by Medicare when it pays a claim.