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Maryland/DC Claim Submission Errors - September 2007 Print

For Contract 00366 - Maryland/District of Columbia

Nbr.	Reason Code	Description	# of RTP Claims	Resolution
1.	32103	The National Provider Identifier (NPI) on the claim is not present on the crosswalk file.	1598	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.
2.	U5233	The admission date or statement from date falls within an HMO risk period.	1514	Ask the patient during the admission if they are enrolled in a Medicare Advantage plan, bill accordingly. It is also important to check HIQA to verify if the record indicates whether the patient is enrolled in a Medicare Advantage plan.
3.	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.	1001	If your claim was submitted with one of these value codes, please remove it and resubmit.
4.	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.	923	Submit the previous month'(s) claim in the order of occurrence.
5.	38113	This inpatient SNF claim (21X only) contains dates of service that overlap a previously processed inpatient ancillary claim (12X or 22X).	805	Verify the dates of service and, if appropriate, add occurrence span code 74 with the dates of service of the ancillary claim.
6.	12302	Covered days: The sum of the utilization days calculated plus the number of the non-utilization days calculated must equal the number of days between the 'from' and 'through' dates in the statement covers period unless: Patient status = 30 (add one day to the calculation) Transfer - the 'from' and 'through' date are the same, patient status 02, 03, 05, 50, 51, 61, 62, 63, 65, 66, 71, or 72 with a condition code 40. The claim must show zero utilization days and one non utilization day. The 'from' and 'through' days are the same but no condition code 40 is present. The claim must have 1 utilization day.	501	Verify that the number of covered days and non-covered days equal the number of days reported in the statement covers period of the claim.
7	19301	If the operating physician is required, or if an operating UPIN is present, the physician's last name and first name must be present. If any name is present, the UPIN must be present or 'NPP' is an invalid UPIN. NPI implementation: When the claim receipt date is on or after the NPI implementation date in the system control file, the operating physician NPI must be present of if the operating physician NPI is present, the physician's last name and first name must be present.	483	When submitting a claim that includes an operating physician, ensure the operating physician UPIN or NPI, last name and first name are present.
8.	31715	It has been determined that the units of service are in excess of the medically reasonable allowance for this service.	579	Verify the dosage and or quantity of the service provided. Next, check the CPT/HCPCS book to determine based on the description that you are billing the appropriate units. Correct your claim as needed.
9.	15202	For Inpatient or SNF claims: The number of covered days on page 1 of the claim, must equal the number of accommodation units associated with revenue codes 10X - 21X on page 2 of the claim.	368	Verify the covered days on page 1 are accurate. If so the covered units on page 2 must match.
10.	U6802	The Medicare Secondary Payer information does not match the MSP information in the Common Working File (CWF).	364	Check HIQA for MSP data, to determine the primary payer. Follow the detailed instructions outlined on the reason code.

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