Medicare claim denials can be frustrating, but one of the most common—and confusing—denials providers face is the N104 Denial Code. This code signals that the claim or service was submitted to the wrong Medicare Administrative Contractor (MAC). In simple terms: the claim landed in the wrong place.
If you’re seeing more N104 denials lately, you’re not alone. With jurisdiction changes, patient moves, and provider location updates, it’s easy for these errors to slip through. But the good news? N104 denials are highly preventable with a little proactive management.
Why Does the N104 Medicare Denial Occur?
Several key factors can trigger an N104 denial:
- Jurisdiction Mismatch: The patient’s address may be outdated or incorrect, causing a MAC mismatch.
- Provider Location Issues: The billing address submitted may fall outside the servicing MAC’s jurisdiction.
- Procedure Code Limitations: Certain codes may not be billable under the MAC where the claim was submitted.
- Medicare Address Changes: The beneficiary may have moved without updating their address with Social Security or Medicare.
- MAC Jurisdiction Updates: Recent CMS updates to MAC boundaries may not be reflected in your system.
- Submission Errors: The claim may have been filed under the wrong practice location or billing entity.
How to Resolve N104 Denials: A Proven Workflow
Here’s a practical, step-by-step process to both resolve existing denials and prevent future ones:
1️⃣ Verify Patient Information Early
- Always double-check the patient’s official address with the Social Security Administration (SSA).
- Ensure the address on file matches where services were performed.
2️⃣ Confirm the Correct MAC Jurisdiction
- Use the official CMS MAC Lookup Tool to confirm which MAC handles claims for that state or region.
- Resubmit the claim to the correct MAC, with verified patient and service location details.
3️⃣ Strengthen Pre-Claim Verification
- Build a workflow that verifies patient demographics, provider credentials, service locations, and billing details before submission.
- Early verification minimizes post-submission surprises.
4️⃣ Invest in Advanced Claim Scrubbing Tools
- Use specialized software that automatically flags jurisdiction mismatches and incomplete data.
- Automated claim scrubbing can reduce denials dramatically and help staff focus on more complex issues.
Don’t Let N104 Denials Disrupt Your Revenue Cycle
Every denied claim slows down payments, frustrates staff, and impacts financial stability. But you don’t have to face these challenges alone. Claims Med provides expert revenue cycle management solutions tailored to Medicare billing. From proactive verification to denial management, we help practices like yours minimize claim rejections and maximize reimbursement.
👉 Let’s talk about how Claims Med can simplify your billing and keep your revenue flowing. Contact us today for a free consultation and see how we can strengthen your practice’s financial health.