Reason Code 19301 - JF Part A

Reason Code Narrative

IF THE OPERATING PHYSICIAN IS REQUIRED OR IF AN OPERATING UPIN IS PRESENT, THE PHYSICIAN'S LAST NAME AND FIRST NAME MUST BE PRESENT. IF ANY NAME IS PRESENT, THE UPIN MUST BE PRESENT. OR NPP' IS AN INVALID UPIN.

NPI IMPLEMENTATION: WHEN THE CLAIM RECEIPT DATE IS ON OR AFTER THE 'SEC NPI:' DATE IN THE SYSTEM CONTROL FILE, THE OPERATING PHYSICIAN NPI MUST BE PRESENT OR IF THE OPERATING PHYSICIAN NPI IS PRESENT, THE PHYSICIAN'S LAST NAME AND FIRST NAME MUST BE PRESENT. INVALID ICD-10 DIAGNOSIS SUBMITTED. NOTE: THE OPERATING UPIN WILL NO LONGER BE REQUIRED FOR CLAIMS RECEIVED ON OR AFTER THE 'ALLOW UPIN:' DATE IN THE SYSTEM CONTROL FILE. REASON CODE WILL NOT ASSIGN WHEN THE DEMO CODE IS '31'. REASON CODE WILL NOT ASSIGN WHEN THE TAPE-TO-TAPE FLAG IS 'U'(ACCRETE CLAIMS). REASON CODE WILL NOT ASSIGN ON FI-INITITED ADJUSTMENTS (TOB FREQ CODE IS ALPHA) REASON CODE 19301 IS ONLY ASSIGNED WHEN COVERED CHARGES ARE PRESENT ON CLAIM AND OPERATING PHYSICIAN ID AND NAME ARE NOT PRESENT.

Common Reason Code Errors

• Claim has been submitted with a HCPCS in the surgical HCPCS range (0001T-0021T, 0024T-0026T, or 10021-59990) without an operating National Provider Identifier (NPI), first name, and last name.
• Operating NPI is on the claim, but the first name and/or last name is not present.
• Operating NPI is invalid or not registered in the Provider Enrollment, Chain, and Ownership System (PECOS).
• Provider's name does not match what is listed in PECOS.

Common Reason Code Corrections

• If a claim contains a surgical HCPCS code, the operating NPI, and first and last name must be present.
• Verify provider name and NPI are correct, and current information is found in PECOS.

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