Reason Code 31947

Reason Code Narrative

A DDE/EMC OUTPATIENT CLAIM HAS A LINE(S) WITH PROVIDER SUBMITTED NON-COVERED CHARGES ARE GREATER THAN ZERO AND ARE EQUAL TO THE TOTAL CHARGES, AND CONDITION CODE 20 OR 21 OR OCCURRENCE CODE 32 IS NOT PRESENT.

Common Reason Code Errors

Condition code (CC) 20, 21 or occurrence code (OC) 32 is not present on the claim to indicate the non-covered reason.

  • OC 32 = Advance Beneficiary Notice (ABN) given; report with appropriate liability-related modifier & covered charges
  • CC 20 = Demand bill will be reviewed
  • CC 21 = No-payment, automatically process

Common Reason Code Corrections

  • This is a valid processing reason code. It does not reflect incorrect billing.

Resource

 

Last Updated Thu, 19 Dec 2019 12:21:47 +0000