CLM-2026-003

Prior authorization pending – cannot submit

💡 Do not resubmit until Medicare approves the prior authorization. Check the Prior Auth section for the current status. Once approved, record the auth number on the claim before submitting — without it the claim will be automatically denied.

Medicare hammertoe coverage criteria not fully documented

💡 Ask the treating physician to add a clinical note documenting that the patient tried conservative treatments first (e.g., padding, orthotics, physical therapy) before surgery. Medicare requires evidence that non-surgical options were attempted and did not resolve the condition.

Prior denial on similar claim – review required

💡 Go to the Denials section and find the previous denial for this patient. Identify the specific reason it was denied, address that issue directly — attach any missing records or corrections — and include a brief cover note explaining what has changed before resubmitting.