1

32151

The Operating physician ID or UPIN is missing or invalid. Prior to the NPI implementation, a valid operating physician UPIN is required.

After the NPI implementation, the operating physician UPIN is not required. However, if it is present, then it must be a valid UPIN.

11240

An operating physician ID must be present if the TOB is a 11X and if there is a procedure code in the first occurrence of your claim. 

Maryland Waiver Hospitals are to repeat the attending physician name and UPIN/NPI number in the operating physician field, when submitting a claim with a code on the ASC listing that is not billed under revenue code 36x.

2

32116

The receipt date of the claim is on or after the NPI implementation date in the system control file and the billing provider NPI is not present on the claim.

2311

Place your National Provider Identifier in primary provider billing and pay to  fields. 

Claims received January 1, 2008 and greater must obtain an NPI in the primary provider billing and pay to fields. 

This edit applies to UB-04 and 837-I billers.

3

34929

Beginning with discharge dates on or after 10/01/07; acute care claims must contain valid values in the present on admission (POA) indicators. Valid values are Y, N, U, W, 1, and “” (spaces). The POA indicators on non acute care claims must be spaces.

1828

Include one of the valid values under the POA indicator; which is the primary and secondary diagnosis fields.  

NON-IPPS Hospitals are required to leave this field blank.  As it was determined that spaces were undesirable.

4

34930

For EMC hardcopy claim with discharge dates prior to 10/01/07 and for DDE claims with discharge dates prior to 01/01/08, the present on admission (POA) indicators and the end of POA indicator should always equal spaces.

1770

Discharge dates prior to 10/01/07 for EMC submitters and 01/01/08 for DDE submitters, remove the POA indicator and resubmit your claim.

5

38119

This inpatient bill has been submitted out of sequence. -

1601

Please verify all prior bills from ‘admit date’ of this claim to the ‘statement from date’ of this claim.  – If any bills between that period of time have not been submitted, or paid yet please hold this bill until this had been done. – If all bills have been submitted in order,please verify that the correct type of bill, patient status code, admit date and HIC number have been used. – If any prior bills have been paid with an incorrect type of bill, patient status,or admit date, please adjust those bills, and after payment has been made on those adjustments,resubmit this claim.

6

U5606

This inpatient hospital or skilled nursing facility’s claim admission date is less than the ‘from’ date and there is no history claim present on the common working file with a ‘through’ date that is equal to the day before the ‘from’ date of this claim.

Inpatient and skilled nursing facility claims must be submitted in sequential order.

1275

Submit the previous month’(s) claim in the order of occurrence.

7

32103

The National Provider Identifier (NPI) on the claim is not present on the crosswalk file.

1135

If your claim was submitted with only an NPI; please apply the appropriate legacy number to the claim.  If the NPI is on the claim and you have verified with the NPPES registry that you are billing the correct NPI, verify on the NPPES website that your tax identification is correct and that your Medicare legacy number is valid.

8

75680

PER CMS CR5680, REQUIREMENT 5680.24 TYPE OF BILL (TOB) 83X IS DISCONTINUED   

FOR SERVICE ON OR AFTER JANUARY 1, 2008,CONTRACTORS SHALL RETURN TO PROVIDER 

(RTP) CLAIMS SUBMITTED ON TYPE OF BILL 83X'.

1016

Verify the claim Type of Bill (TOB) and resubmit.    83x bill types are no longer an acceptable type of bill. 

9

39012

951

The remarks page (pg. 4)  of your claim must be given in the exact format as given below (letter for letter, space for space, etc…)

JUSTIFY: MSP INVOLVEMENT                                             

JUSTIFY: SSA INVOLVEMENT                                             

JUSTIFY: PRO REVIEW INVOLVED                                         

JUSTIFY: OTHER INVOLVEMENT                                           

* ON THE NEXT LINE, UNDER " JUSTIFY: ", DETAILED COMMENTS MUST BE PRESENT.    

Update your remarks and resubmit. 

10

31259

Value Codes A1, A2, A3, B1, B2, B3, C1, C2 and C3 are not allowed on the entry of direct data entry claim effective with dates on or after July 1, 2007.

838

Value codes are acceptable for paper claims only.  If your EMC claim was submitted with one of these value codes, please remove it and resubmit.