Wednesday, October 29, 2014

PART A - Reject reason code and steps to avoid this rejections - 34538 and 39929


Q: We are receiving reject reason code 34538, so what steps can we take to avoid this reason code?

Reason Code : 34538
Description : CLAIM SUBMITTED AS MEDICARE PRIMARY AND A POSITIVE WORKING ELDERLY RECORD EXISTS AT CWF. THE CONTRACTOR ID EQUAL TO '11121'. THE CLAIM SHOULD BE BILLED TO THE EMPLOYER GROUP HEALTH PLAN.

A: You are receiving this reason code when the beneficiary or the spouse was/is working for the date of service(s) and the employer’s insurance is primary to Medicare.
• Upon patient registration and prior to submitting the claim, have the beneficiary complete the Medicare secondary payer (MSP) questionnaire.
• Confirm the beneficiary’s eligibility via direct data entry (DDE), the interactive voice response (IVR) system, or take advantage of the Secure Provider Online Tool (SPOT), where you can view claims status, eligibility and benefits, payment information, and comparative billing data in a secure online environment. File the claim to the primary insurance listed on the beneficiary’s records and then to Medicare for secondary payment consideration


Reject reason code 39929 FAQ
Q: We are receiving reject reason code 39929, so what steps can we take to avoid this reason code?
Reason Code : 39929
Description : THIS CLAIM HAS REJECTED DUE TO ALL LINES ITEMS HAVE REJECTED AND/OR REJECTED AND DENIED. REVIEW EACH LINE ITEM TO IDENTIFY THE APPLICABLE LINE EDIT, AND UTILIZE THE REASON CODE NARRATIVES TO IDENTIFY POSSIBLE BILLING ERROR(S). IF THE PRIMARY PROCEDURE LINE IS NOT PAYABLE DUE TO AN EDIT ASSIGNED,THEN ALL INCIDENTAL LINES ON THE SAME DATE OF SERVICE WILL NOT BE PAYABLE DUE TO OTHER RELATED EDITS. *****************************************************************************

IF AN ADJUSTMENT NEEDS TO BE SUBMITT ED TO CORRECT BILLING ERROR(S) ON A REJECTED LINE ITEM, THEN EACH APPLICABLE LINE ITEM WILL NEED TO BE DELETED AND RE-KEYED IN ITS ENTIRETY IN ORDER FOR THE PREVIOUS EDIT TO BE DELETED. ALSO, REMEMBER INCIDENTAL LINES WILL NEED TO BE DELETED AND RE-KEYED.

A: You are receiving this reason code which indicates the claim has rejected due to all line items rejecting and/or rejected and denied. There could be several reasons your claim is receiving this reject reason code. There are several ways you can review the claim and see the line item reason code:

Direct data entry (DDE) users -- open the claim Once you have this reason code, you can PF1 and key the number in the reason code field to pull the description.
• If the claim is in a rejected status, you may adjust the claim, fix the line item, and resubmit.
• If the claim is in a denied status, you may not adjust a denied line item. You must go through the appeals process.
• Review the 201 report through DDE for history of the claims submitted.
• Review the remittance advice to obtain a history of the claims submitted.
There can be numerous reason codes that can fall under the code 39929. A few examples of a line item reason code is:
• W7049 -- service on the same day as inpatient procedure
• W7018 -- inpatient procedure

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