Reason Code 37537 - JE Part A

Reason Code Narrative

UB92 PROVIDER SUBMITTED ADJUSTMENT (XX7) AND IS MAKING AN ORIGINAL NO PAY CLAIM A PAYMENT CLAIM. NON PAY CODE ON ORIGINAL EQUALS 'C ', 'B ', 'E', 'N ', 'R ', 'X ' 'Y ' OR 'Z '.

Common Reason Code Errors

• A non-covered claim is being moved to covered on an adjustment and claim change condition code D1 is not being billed
• Medicare is being changed to primary or secondary and the appropriate claim change condition code is not billed
• Claim change condition code is billed but a more appropriate claim change condition code is available

Common Reason Code Corrections

• Changes made to total covered charges must be billed with a D1 claim change condition code.

Resource

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 1, Section 130.1.2

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