Reason Code 31947 - JE Part A

Reason Code Narrative

A DDE/EMC OUTPATIENT CLAIM HAS A LINE(S) WITH PROVIDER SUBMITTED NON-COVERED CHARGES ARE GREATER THAN ZERO AND ARE EQUAL TO THE TOTAL CHARGES, AND CONDITION CODE 20 OR 21 OR OCCURRENCE CODE 32 IS NOT PRESENT.

Common Reason Code Errors

The provider submitted charges on the claim as non-covered. Condition code (CC) 20, 21 or occurrence code (OC) 32 is not present on the claim to indicate the non-covered reason.

• OC 32 = Advance Beneficiary Notice (ABN) given; report with appropriate liability-related modifier & covered charges
• CC 20 = Demand bill will be reviewed
• CC 21 = No-payment, automatically process

Common Reason Code Corrections

• Add the appropriate condition or occurrence code above, along with other claim information if required.

Resource

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 1, Section 60.4.2

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