Reason Code 30940 - JE Part A

Reason Code Narrative

A PROVIDER IS NOT PERMITTED TO ADJUST A PARTIALLY OR FULLY MEDICALLY DENIED CLAIM

THIS REASON CODE IS ASSIGNED WHEN THE FOLLOWING CONDITIONS ARE TRUE.

• FREQUENCY CODE IS '7' OR THE TRANSACTION TYPE IS 'D'
• ADJUSTMENT REQ CODE IS 'H'
• HISTORY CLAIM CURRENT STATUS IS 'D' OR 'R'
• HISTORY CLAIM REJECT CODE BETWEEN 50000 THRU 59999
• HISTORY CLAIM USER ACTION CODE IS = TO 'A' THRU 'D' OR 'F' THRU 'P' OR 'R' THRU 'Y' OR 'AR' THRU 'DR' OR 'FR' THRU 'PR' OR 'RR' THRU 'YR'

OR

• FREQUENCY CODE IS '7' OR THE TRANSACTION TYPE IS 'D'
• ADJUSTMENT REQ CODE IS 'H'
• HISTORY CLAIM CURRENT STATUS IS 'P'
• HISTORY CLAIM USER ACTION CODE IS = TO 'A' THRU 'D' OR 'F'
• THRU 'P' OR 'R' THRU 'Y' OR 'AR' THRU 'DR' OR 'FR' THRU 'PR'
• OR 'RR' THRU 'YR'

OR

• WHEN AN ADJUSTER REQUESTOR ID OF AN 'H' IS SUBMITTED WITH AN XREF DCN OF A PAID CLAIM WHICH CONTAINS AN 'M' IN OCE FLAG 1 ON ANY 0023 REVENUE LINE.

OR

• FREQUENCY CODE IS '7' OR THE TRANSACTION TYPE IS 'D'
• ADJUSTMENT REQ CODE IS 'H'
• HISTORY CLAIM CURRENT STATUS IS 'D' OR 'R'
• HISTORY CLAIM REJECT CODE IS 39929 AND AT LEAST ONE LINE ITEM HAS A REJECT CODE BETWEEN 50000 THRU 59999
• HISTORY CLAIM USER ACTION CODE IS = TO 'A' THRU 'D' OR 'F' THRU 'P' OR 'R' THRU 'Y' OR 'AR' THRU 'DR' OR 'FR' THRU 'PR' OR 'RR' THRU 'YR'

Common Reason Code Errors

• There is a medically denied line on original claim and provider is attempting to submit an adjustment, making changes to line
• A medically denied line is being removed from claim

Common Reason Code Corrections

• If claim contains a medically denied line, the only allowed changes are:
  • Change to beneficiaries' Medicare number
  • Removal of charges not previously medically denied
  • Medicare Secondary Payer (MSP) adjustments making Medicare either primary or secondary
  • An increase in charges to a revenue code line that was not denied by Medical Review
• If original claim does not include medically denied/reviewed lines, Direct Data Entry (DDE) users may F9 claim to reprocess
• "Comments/Remarks" must include changes being made
• Any other change not listed above must be submitted as an appeal

View reason code list, return to Reason Code Guidance page.