Reason Code 34977

Reason Code Narrative

Assigns when:

The TOB is equal to 13X or 14X, the Provider PTAN/OSCAR range is equal to XX0001-XX0999, XX1200-XX1299, XX3025-XX3099, XX3300-XX3399, or XX4000-XX4499, the statement FROM date is on or after 11/02/2015, and the address is present on MAP171F, claim page 03, (for DDE claims) or MAP103M, claim page 42 (for Hardcopy claims) and does not match the address with EFF/TERM date range (including statement FROM date of claim) on the Provider Practice Address Query Screen (MAP1AB2).

Common Reason Code Errors

Address submitted on claim is not an exact match to what is entered in the Provider Enrollment Chain and Ownership System (PECOS).

Common Reason Code Corrections

  • Validate address submitted on the claim and ensure it is an exact match to what is entered in PECOS.
    • Direct Data Entry (DDE) users
    • Each character, even if it's a space, is considered in system match
    • Line items must match up
      • I.e., if a suite number is on address line 2 in PECOS, it cannot be on line 3 of claim submission
    • Abbreviations must match
      • I.e., if PECOS has "St" and claim is submitted with "Street" this will cause edit to assign
  • If the address is an off-campus provider-based location and has not been entered on the 855A, and the facility has not been deemed grandfathered, the address must be added to the 855A via PECOS.

Resource

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

 

Last Updated Mar 20, 2019