Most Frequent RTP Reason Codes - Palmetto GBA

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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
Reason Codes FISS Narrative OF BILL AND/OR THE TOTAL COVERED CHARGES REPORTED. PLEASE CORRECT AND RESUBMIT/REKEY. HARDCOPY SUBMITTORS RESUBMIT RTP REPORT WITH CORRECTIONS. Explanation and Suggestion claim are listed as covered charges. In some cases the type of bill may be reported incorrectly. If this is the case please update the type of bill (TOB). If this is in fact a no pay and/or non-covered claim, the charges must be moved to the non-covered column. If you encounter some other reason code that you are unable to decipher, please submit it to us using the “I Have a Question” form included in the Medicare Advisory.
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Most Frequent RTP Reason Codes - Palmetto GBA

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