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Thursday, January 7, 2016

RTP reason codes 153XX to 154XX, 30912, 30949 FAQ

Q: What steps can we take to avoid return to provider (RTP) reason code(s) 153XX-154XX?

A: Claims that RTP with reason codes 153XX-154XX indicate that the total charges revenue line 0001 contains a charge not equal to the sum total of all line items billed (covered and non-covered) on the claim.

There may have been updates or changes to some of the line items billed, but the total charge line was not deleted and re-entered with the correct amount.

To avoid this reason code from recurring, the following steps should be taken prior to updating the claim:

• Verify total charges for all line items billed (covered and non-covered)
• Delete revenue code line 0001 and re-key calculated charges

Direct Data Entry (DDE)

The processes for deleting and re-keying revenue code lines are outlined below:
• Access the claims correction menu under option 03
• Enter the appropriate selection that matches your provider type
• Enter the National Provider Identifier (NPI), then T B9997 in the S/LOC field
• Select the claim under the SEL field
• Go to claims page 02 or the MAP1712 screen
• Do not key over the existing line item when making corrections (such as, revenue codes, units, charges, etc.)
• Delete line(s) requiring revisions, by keying D000 over the revenue code, press the ‘Home’ key, then ‘Enter’
• Add line items back to the claim by typing in the new revenue code line information under the 0001 line, press the ‘Home’ key, then ‘Enter’
• Update the total charge and/or non-covered charge amount on the 0001 revenue code line to reflect the correct amount
• Press the ‘F9’ key for claim submission

Q: What steps can we take to avoid return to provider (RTP) reason code 30912?

A: An adjustment claim (type of bill XX7) was submitted with an incorrect cross-reference document control number (DCN), or you are attempting to adjust a previously adjusted/cancelled DCN. The following actions should be taken prior to submitting an adjusted claim:
• Ensure the cross reference DCN is correct and complete for the claim being adjusted
• Centers for Medicare & Medicaid Services (CMS) form 1450, field locator (FL) 64 or electronic equivalent
• Direct Data Entry (DDE) claim screen page 01, MAP1711
• Submit a new claim if the original claim has been cancelled (type of bill XX8)
• Submit an adjusted claim if the original claim has been adjusted (type of bill XX7)

We are receiving a return to provider (RTP) reason code 30949, so what steps can we take to avoid this reason code?

A: You are receiving this reason code when the type of bill (TOB) equals xx7 or xx8, but the claim change reason ‘condition code’ is not present on the bill.
Condition codes:
• 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
• E0 - Change in patient status
Please add the appropriate condition code listed above in the reason code narrative to correct your claim(s) and resubmit

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