Returned to Provider (RTP) Help

Claims that are Returned To Provider (RTP) are considered unprocessable. Provider corrections and resubmission of an RTP claim will apply a new receipt date to the claim. A new receipt date changes the date the claim processes for payment as well as the date interest begins to apply. Claims that RTP, which are not corrected and resubmitted by the provider recycle into Noridian, are inactivated every 60 days by the datacenter. Consequently, providers will need to submit a new claim if this occurs. The following list contains common reason codes why claims are RTP for correction.

 
Reason Code Description Resolution
12206 When the from and through date are not the same on an inpatient or SNF bill type (11X, 18X, 21X, 28X, 41X or 51X) the number of days represented must equal the sum of the covered plus non-covered days, unless the patient status code is equal to a 30, then 1 additional day is added. Research to determine the correct number of days and units compared to the statement dates.
13599 Duplicate condition codes are present on the claim record. Research to determine if duplicate occurrence codes exist on the claim.
17712 Billing NPI is the same as the attending physician NPI. Research to determine if the NPIs are the same.
19301 If the operating physician is required, or if an operating NPI is present, the physician's last name and first name must be present. If any name is present, the NPI must be present. Research to determine if the Operating Physician NPI number is present without the provider last name, first name and middle initial or if the provider last name, first name and middle initial are present without the NPI number.
30905 There is no record of processing an original claim for this adjustment. Research to determine if the correct Medicare number is present, the correct 14-digit cross-reference DCN number is present, the dates of service or provider number are present.
30912 This adjustment is adjusting a claim that has been previously adjusted. Research to determine if the claim you are adjusting has already been adjusted.
30921 If a claim contains a cross reference Document Control Number (DCN), the type of bill must be that of an adjustment or cancel. Research to determine the appropriate type of bill for the type of claim submitted.
30940 A provider is not permitted to adjust a partially or fully medically denied claim. Research to determine if the claim has been denied or if a line has been denied. If so, charges must remain in non-covered and you must enter comments/remarks stating that you are not adjusting a medically denied line. If you are trying to put the charges for a medically denied line or claim into covered, submit as an appeal.
30955 The Xref DCN has been changed to an invalid DCN. For a cancel TOB (XX8) the Xref DCN dos not equal the cancel DCN. Research to determine if a valid DCN was billed in the Xref DCN field.
31300 Invalid payer ID. Research to determine the correct payer ID.
31361 An occurrence code 24 is present on the claim without a value code. Research to determine the appropriate value code and amount to submit.
31577 The same revenue code 0520-0525 or 0528 is billed multiple times for the same date of service. Research to determine if multiple revenue codes are billed on the same date of service.
31592 HCPC billed that is not allowed on the TOB submitted. Research to determine if your TOB and HCPC can be submitted together.
31620 Ambulance claims require A0 with a zip code. Research to determine if your claim is missing the A0 value code and zip code.
32005 The statement covers from date is greater than the provider's effective date on the provider file. Research to determine if the provider number submitted is correct.
32006 The statement covers to date is greater than the provider's cancel date on the provider file. Research to determine if the provider number submitted is correct.
32078 Type of bill is equal to a 71X or 73X and incorrect revenue codes exist. Research to determine if incorrect revenue code was submitted.
32200 Diagnosis V0481 is present and the claim does not contain condition code A6. Research to determine if condition code A6 is missing from the claim.
32206 The revenue code is not valid for this type of bill or must be billed as a non-covered charge. Research to determine if the revenue code is allowed for the type of bill.
32374 TOB 77X and HCPC 99406 and 99407 can only be submitted with revenue code 052X. Research to determine if the HCPC was submitted on the correct revenue code.
32402 A HCPC is required for the line item being edited. Research to determine the appropriate HCPC for the line billed.
36177 Hemodialysis claim submitted with a from date less than the certification on the provider file. Research to determine that the DOS is not after a certification termination date.
36602 The claim contains a revenue code and/or HCPC that price by a fee amount, but may not be allowed on your type of bill. Research to determine if the HCPC and/or revenue code combination is allowed for the type of bill (TOB) submitted
37544 Provider submitted adjustment indicates the adjustment is due to changes in charges. Condition code D1 is present, but all charges on the adjustment bill equal the charges on the original. Research to determine if there was a change in the covered charge column.
37590 The MA-ID returned by CWF on trailer 05 does not match any of the MA-IDS on the provider supplemental payment rates record. Research to determine if the correct MA-ID was entered on the claim or if an error exists at CWF.
38032 This outpatient claim is a possible duplicate to a previously submitted outpatient claim. Research to determine if this outpatient claim is a duplicate to a previously submitted outpatient claim.
38105 Outpatient claims with overlapping dates from same provider. Research to determine if an overlap exists. Check for use of condition code G0 where applicable.
38119 The statement covers from date is greater than the admission date and there is no claim pending with a thru date 1 day less than the claim's from date. Research to determine if the appropriate dates were accounted for on the claim.
38204 Partial hospitalization claim with condition code 41 does not find a history partial hospitalization claim for the same beneficiary and provider with a line item within 7 days prior to the from date for the incoming claim. Research to determine if condition code 41 is present and there is no history partial hospitalization claim for the same provider with a line item date within 7 days prior to the from date of the incoming claim.
39011 Claim has failed the timeliness of submission edit. Research to determine if claim is past timely filing deadline. Add any supporting comments to the remark page. For timeliness schedule please review the dates posted on the noridianmedicare.com website under the claims tab.
C7114 An outpatient claim contains therapeutic services against a posted inpatient history claim. Research to determine if the claim contains therapeutic services.
E0401 The type of bill is invalid or inconsistent with the provider number. Research to determine if the type of bill and/or provider number is inconsistent.
N5052 Beneficiary Identification Incorrect. The name and/or claim number shown on the claim is incorrect. Research to determine if the correct name/number is present.
W7072 Service not billable to the Fiscal Intermediary/MAC. Research to determine if the service is billable to Medicare.

 

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