Reason Code 34977 - JE Part A

Reason Code Narrative

Assigns when:

The TOB is equal to 13X or 14X, the Provider PTAN/OSCAR range is equal to XX0001-XX0999, XX1200-XX1299, XX3025-XX3099, XX3300-XX3399, or XX4000-XX4499, the statement FROM date is on or after 11/02/2015, and the address is present on MAP171F, claim page 03, (for DDE claims) or MAP103M, claim page 42 (for Hardcopy claims) and does not match the address with EFF/TERM date range (including statement FROM date of claim) on the Provider Practice Address Query Screen (MAP1AB2).

Common Reason Code Errors

Address submitted on claim is not an exact match to what is entered in the Provider Enrollment Chain and Ownership System (PECOS).

Common Reason Code Corrections

• Validate address submitted on the claim and ensure it is an exact match to what is entered in PECOS.
  • Direct Data Entry (DDE) users
    • Go to page three of any claims menu and press F11 twice to access MAP171F
    • Enter practice address found in Provider Practice Address Query Summary, Option 1D [PDF], MAP1AB1
    • 1D screen displays the address as found in PECOS
  • Each character, even if it's a space, is considered in system match
  • Line items must match up
    • I.e., if a suite number is on address line 2 in PECOS, it cannot be on line 3 of claim submission
  • Abbreviations must match
    • I.e., if PECOS has "St" and claim is submitted with "Street" this will cause edit to assign
• If the address is an off-campus provider-based location and has not been entered on the 855A, and the facility has not been deemed grandfathered, the address must be added to the 855A via PECOS.
  • View PECOS Enrollment Tutorial - Change of Information for an Organization/Supplier for assistance in updating the address location

Resource

• 42 Code of Federal Regulations (CFR) 413.65
• Medicare Learning Network (MLN) Matters (MM) 9613
• Noridian Provider-Based Facilities
• Section 1833 (t)(21)(B)(iv)(II) of the Social Security Act
• Special Edition (SE) 18023

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