Reason Code 31023

Reason Code Narrative

THERE IS A NON-PAYMENT CODE PRESENT AND IT IS NOT EQUAL TO 'R', 'N' OR 'Z' THE TOTAL COVERED CHARGES ARE GREATER THAN ZERO, OR THERE IS NO NON-PAYMENT CODE PRESENT, TOTAL COVERED CHARGES ARE EQUAL TO ZERO.

Common Reason Code Errors

  • An adjustment claim is submitted to a rejected claim and charges are left in non-covered on adjustment. DDE users will need to delete and rekey entire line to ensure line item rejection is removed
  • A claim is submitted without appropriate non-payment coding

Common Reason Code Corrections

  • Providers should verify if days/units are to be billed as covered or non-covered. If days/units are non-covered, bill with type of bill (TOB) xx0, condition code 20/21 and occurrence span codes and corresponding dates for non-covered days
  • Condition code 20 should be billed if beneficiary has requested that determination be made by Medicare (e.g., a demand bill) on coverage of services. Condition code 21 should be billed if provider is requesting a denial notice from Medicare for use in billing another payer

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

Last Updated Oct 19, 2018