1

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.

13205

Discharge dates of 10/01/07 and after for EMC submitters and discharge dates of 01/01/08 and after for DDE submitters,  must obtain a valid value in the present on admission (POA) indicator.  Include one of the valid values under the POA indicator; which is the primary and secondary diagnosis fields.  

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.

8757

Place your National Provider Identifier (NPI) in the primary 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

38119

The type of bill is equal to a SNF or this claim is for a non-PPS inpatient.  The statement covers from date is greater than the admission date, but there is no claim pending with a through date one day less than this claim’s from date.  Providers are required to bill SNF and non-PPS bills in sequence.  This claim cannot be finalized until prior bill/s is received and processed.

1770

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

4

32103

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

1625

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.

5

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.

1496

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.

6

32404

This claim has been returned due to a HCPC billing error.  Either a revenue code is present requiring a HCPC, or a HCPC code on the claim is no longer valid, or a HCPC code on the claim does not exist on the HCPC file.

If the charge associated with the invalid HCPCS was moved to the non-covered column, it must be moved back to the covered column.

1470

Prior to submission of a claim, verify the HCPCS billed and the revenue code combination billed.

Utilize various resources to verify your HCPCS code and/or revenue code combination.

If the charge associated with the invalid HCPCS was moved to the non-covered column, those charges must be moved back to the covered column.

7

W7062

Code not recognized by OPPS; alternate code for same service may be available.

984

Verify the code reported is appropriate for OPPS

Search Addendum B on the CMS website

8

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.

841

If you appended the Present on Admission (POA) indicator, Y, N, U, W or 1, please removed the indicator.  It is not required for discharge dates prior to 10/01/07 for EMC submitters and 01/01/08 for DDE submitters.

9

38117

The type of bill is equal to a SNF or claims for a non-PPS inpatient and the statement covers from date is greater than the admission date, there is a prior claim pending and the prior claim’s thru date is 1 day less than this claim’s from date.

821

You must wait until the previous months claim has processed before sending the claim.  The previous months claim should be in either a PB9996 or PB9997 status location.

10

19301

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.

797

When submitting a claim that includes an operating physician, ensure the operating physician UPIN or NPI, last name and first name are present.