February 1, 2000

Medi-751-00

TO: ALL MEDICARE PROVIDERS

SUBJECT: CURRENT REASONS FOR RETURNED CLAIMS

PRIMARY INTERESTS: BUSINESS OFFICE MANAGERS

The purpose of this bulletin is to share with provider billing staff some of the most common reasons we are returning claims to providers via the 201 Report. The following are the reason codes we have encountered with significant volume in recent weeks. Please identify those applicable to your claims and take measures to minimize them. This will allow us to process your claims as quickly as possible under the guidelines established by the Health Care Financing Administration.

Reason Code

Description

 

 

W0452

Invalid diagnosis code, either too few or too many digits. The code should be listed to the last digit level possible as outlined in the ICD-9 Manual.

 

 

19903

Rural Health Clinic claim must have clinic visit revenue code ( 51x, 52x, 910).

 

 

11501

Admission date (UB92 block 15) must be in a valid numeric format.

 

 

30921

The claim contains a cross-reference Document Control Number (assigned by Riverbend GBA), but the type of bill does not indicate the claim is an adjustment.

 

 

31201

The date of the first occurrence code is greater than the last date of service on the claim.

 

 

W0683, W0682

The HCPCS code being billed can only be billed by a physician on the HCFA-1500 form to the Part B Carrier. For Rural Health Clinics that can bill the service to RGBA, omit the HCPCS code when billing on the UB92 to RGBA.

 

 

32400

Required HCPCS code is missing.

 

 

15701

The payer line (50 A-C) that applies to Medicare cannot have contain anything other than the phrase "Medicare".

 

 

19201

UPIN number is missing.

 

 

32403

HCPCS code billed is invalid for the dates of service.

 

 

31023

A no-pay claim has been filed without an indication of the reason for non-coverage.

 

 

THIS BULLETIN SHOULD BE SHARED WITH ALL HEALTH CARE PRACTITIONERS AND MANAGERIAL MEMBERS OF THE PROVIDER STAFF. NO COST COPIES ARE ALSO AVAILABLE FROM OUR WEB SITE AT riverbendgba.com

 

 

Please refer any questions to our office at (423) 755-5950.

 

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