5CFH9: Physician Narrative Statement Not Present or Not Valid

Published 05/14/2019

The claim has been denied as the physician narrative statement is not present or not valid.

How to Prevent This Denial

  • The physician must include a brief narrative explanation of the clinical findings that supports a life expectancy of six months or less as part of the certification and recertification forms, or as an addendum to the certification and recertification forms
  • If the narrative is part of the certification or recertification form, then the narrative must be located immediately prior to the physician’s signature
  • If the narrative exists as an addendum to the certification or recertification form, in addition to the physician’s signature on the certification or recertification form, the physician must also sign immediately following the narrative in the addendum
  • The narrative shall include a statement with the physician signature attesting that by signing, the physician confirms that he/she composed the narrative based on his/her review of the patient’s medical record or, if applicable, his or her examination of the patient
  • The narrative must reflect the patient’s individual circumstances and cannot contain check boxes or standard language used for all patients

Resources


Was this article helpful?

Palmetto GBA Web Chat

Sounds: OnSave Transcript
Please answer the questions below. Additional fields may appear based on previous answers. Fields with a red asterisk (*) are required.
Your InformationClear
1()-x
Inquiry InformationClear
Select your stateClear
Select your stateClear
Provider InformationClear
Patient InformationClear
Patient Name must exactly match the information submitted on the claim, including suffix if applicable.
//
Appeal InformationClear
//
//
Claim InformationClear
//
//
Denial InformationClear
//
//
Rejection InformationClear
DDE InformationClear
Restore InformationClear
//
Prior Authorization InformationClear
//
//
Application InformationClear
Product InformationClear
OtherClear
Additional InformationClear

Are you sure you want to end your chat?

Keep ChattingClose ChatSave Transcript & Close

Webchat

Our dedicated webchat representatives are online to assist you with your general inquiries, provider enrollment, EDI, eServices and more in real-time.