Reason Code 30905 - JF Part A

Reason Code Narrative

NO RECORD OF PROCESSING AN ORIGINAL CLAIM FOR THIS ADJUSTMENT. VERIFY MEDICARE ID, X-REFERENCE DCN, DOS, AND/OR PROVIDER NUMBER.

Common Reason Code Errors

• Assigns to adjustment claims (XX7 type of bills) that have been submitted with the incorrect or incomplete Document Control Number (DCN) into Form Locator (FL) 64 of the UB04 form (or electronic equivalent).
• The DCN number is submitted without alpha characters (e.g. 12345678912345 instead of 12345678912345AAA).

Common Reason Code Corrections

• If DCN number submitted is correct and complete, F9 claim if using Direct Data Entry (DDE).
• Verify that entire DCN is billed correctly. If adjustment was not submitted with correct DCN, submit a new adjustment (XX7) type of bill with correct DCN.

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