Reason Code 30940

Reason Code Narrative

A PROVIDER IS NOT PERMITTED TO ADJUST A PARTIALLY OR FULLY MEDICALLY DENIED CLAIM

THIS REASON CODE IS ASSIGNED WHEN THE FOLLOWING CONDITIONS ARE TRUE.

  • FREQUENCY CODE IS '7' OR THE TRANSACTION TYPE IS 'D'
  • ADJUSTMENT REQ CODE IS 'H'
  • HISTORY CLAIM CURRENT STATUS IS 'D' OR 'R'
  • HISTORY CLAIM REJECT CODE BETWEEN 50000 THRU 59999
  • HISTORY CLAIM USER ACTION CODE IS = TO 'A' THRU 'D' OR 'F' THRU 'P' OR 'R' THRU 'Y' OR 'AR' THRU 'DR' OR 'FR' THRU 'PR' OR 'RR' THRU 'YR'

--OR--

  • FREQUENCY CODE IS '7' OR THE TRANSACTION TYPE IS 'D'
  • ADJUSTMENT REQ CODE IS 'H'
  • HISTORY CLAIM CURRENT STATUS IS 'P'
  • HISTORY CLAIM USER ACTION CODE IS = TO 'A' THRU 'D' OR 'F'
  • THRU 'P' OR 'R' THRU 'Y' OR 'AR' THRU 'DR' OR 'FR' THRU 'PR'
  • OR 'RR' THRU 'YR'

--OR--

  • WHEN AN ADJUSTER REQUESTOR ID OF AN 'H' IS SUBMITTED WITH AN XREF DCN OF A PAID CLAIM WHICH CONTAINS AN 'M' IN OCE FLAG 1 ON ANY 0023 REVENUE LINE.

--OR--

  • FREQUENCY CODE IS '7' OR THE TRANSACTION TYPE IS 'D'
  • ADJUSTMENT REQ CODE IS 'H'
  • HISTORY CLAIM CURRENT STATUS IS 'D' OR 'R'
  • HISTORY CLAIM REJECT CODE IS 39929 AND AT LEAST ONE LINE ITEM HAS A REJECT CODE BETWEEN 50000 THRU 59999
  • HISTORY CLAIM USER ACTION CODE IS = TO 'A' THRU 'D' OR 'F' THRU 'P' OR 'R' THRU 'Y' OR 'AR' THRU 'DR' OR 'FR' THRU 'PR' OR 'RR' THRU 'YR'

Common Reason Code Errors

  • There is a medically denied line on original claim and provider is attempting to submit an adjustment, making changes to line
  • A medically denied line is being removed from claim

Common Reason Code Corrections

  • If claim contains a medically denied line, the only allowed changes are:
    • Change to beneficiaries' Medicare number
    • Removal of charges not previously medically denied
    • Medicare Secondary Payer (MSP) adjustments making Medicare either primary or secondary
    • An increase in charges to a revenue code line that was not denied by Medical Review
  • If original claim does not include medically denied/reviewed lines, Direct Data Entry (DDE) users may F9 claim to reprocess
  • "Comments/Remarks" must include changes being made
  • Any other change not listed above must be submitted as an appeal

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

Last Updated May 22, 2018