Most Frequent RTP Reason Codes - Palmetto GBA

Reason
Codes
FISS Narrative
Explanation and Suggestion
153#1 TOTAL CHARGES: THE TOTAL CHARGES
ON REVENUE CODE 001 MUST BE EQUAL
TO THE SUM OF ALL THE CHARGES
ABOVE IT.
30949 TYPE OF BILL EQUALS XX7 OR XX8 BUT
NO CONDITION CODE IS PRESENT ON THE
BILL. PLEASE INCLUDE THE APPROPRIATE
CONDITION CODE OF
D0 - CHANGES TO SERVICE DATES
D1 - CHANGES IN CHARGES
D2 - CHANGES IN REVENUE CODE/HCPC
D3 - SECOND OR SUBSEQUENT INTERIM
PPS BILL
D4 - CHANGE IN GROUPER INPUT (DRG)
D5 - CANCEL ONLY TO CORRECT A HIC OR
PROVIDER NUMBER
D6 - CANCEL ONLY - DUPLICATE
PAYMENT, OUTPATIENT TO INPATIENT
OVERLAP, OIG OVERPAYMENT
D7 - CHANGE TO MAKE MEDICARE
SECONDARY PAYER
D8 - CHANGE TO MAKE MEDICARE
PRIMARY PAYER
D9 - ANY OTHER CHANGES.
PLEASE MAKE CORRECTIONS AND
RESUBMIT/REKEY.
13314 FOR OCCURRENCE SPAN CODE
70(QUALIFYING STAY DATE) THE "FROM"
DATE IS GREATER THAN THE "THROUGH"
DATE. *VERIFY THE QUALIFYING STAY
THRU DATE (REPORTED WITH
OCCURRENCE CODE 70) IS GREATER
THAN THE ADMISSION DATE OF THE
CLAIM.
OR
THIS IS A SNF, AND THE OCCURRENCE
SPAN CODE 80 (PRIOR SAME-SNF STAY)
FROM DATE IS GREATER THAN THE CLAIM
ADMISSION FROM DATE.
31094 TOTAL COVERED CHARGES CANNOT BE
GREATER THAN ZERO IF THE THIRD
POSITION OF THE TYPE OF BILL (TOB)
EQUALS ZERO. PLEASE VERIFY THE TYPE
This reason code indicates that the Total
Charges revenue line (0001) contains a charge
that is not the sum total of the line items on this
claim. This may be an indication that some line
item changes were made but the Total Charge
line was not “deleted” and re-entered with the
corrected total charge amount. If the Total
Charge line item is not “corrected” in the same
manner as all other line items, this reason code
is likely to occur.
In this instance, the provider is submitting an
adjustment (type of bill = xx7) or a paid claim
cancellation (xx8), but they have failed to
include the claim change condition code (FL
24-30) that explains the adjustment or
cancellation. Please add one of the condition
codes listed in the reason code narrative to
your claim.
On most of the claims receiving this reason
code the Admission Date billed on the claim is
BEFORE the qualifying stay date (occurrence
code 70) which is incorrect. It appears that an
”old” (prior) admit date is being used rather
than the admit date that relates to the from and
through dates on the current claim. Please
review the admit date, the qualifying stay date
and the from and through date on the claim to
assure that the appropriate, current dates are
being used and that they are in the proper
sequence.
This reason code is received because the claim
is billed with a zero (0) in the third position of
the type of bill (TOB) indicating a no pay and/or
non-covered claim, but the charges on the