Most Frequent RTP Reason Codes - Palmetto GBA

ReasonCodesFISS Narrativebeing billed is valid for the dates of service onthe claim.32005 The statement covers from date is less thanthe provider's effective date on the providerfile. Note: for the following type bills, use theeffective date in the inpatient Provider Filerecord: 11x, 18x, 21x, 28x, 32x, 33x, 34x, 41x,51x, 75x. For all other type bills, use theeffective date in the outpatient Provider Filerecord.32011 The statement covers from date is before theprovider's fiscal start date, and the statementcovers to date is after the provider's fiscal startdate. Verify the information billed. Pleasecorrect and resubmit/rekey.Hardcopy submitters resubmit rtp report withcorrections.Explanation and SuggestionThis error usually occurs as a result of aprovider billing for a date of service that is priorto its official effective date under the submittedprovider number. Frequently this will occurwhen a provider is changing its billing statusand provider number, such as changing from anacute care PPS hospital to a critical accesshospital (CAH). The “from” date on the claimmust be changed to a date equal to or after theProvider File effective date.This reason code is usually secondary toreason code 32005 (which see above). The“from” date on the claim must be changed to adate equal to or after the provider’s fiscal startdate contained in the Provider File.32063 The statement covers from and through dateon this claim is before your fiscal year startdate on the Provider File. Please verify that thedates on the claim are correct; if the dates arenot correct, make changes and re-sendThe claim for processing. If dates on the claimare correct and the date on the date on theprovider is incorrect, pleaseContact our service center staff.This reason code is frequently received inconjunction with reason code 32005 (which seeabove). However, this error can also occurwhen a provider is billing for very old dates ofservice which may be before the fiscal periodsbeing maintained on the Provider File. If this isthe case, the provider should contact thePalmetto GBA provider contact center (PCC) toreport this problem.If you encounter some other reason code that you are unable to decipher, please submit it to ususing the “I Have a Question” form included in the Medicare Advisory.