Reason Code 34978

Reason Code Narrative

This Reason Code will assign when:

The Type of Bill (TOB) is equal to 13X or 14X,
-And-
The Provider PTAN/Oscar ranges are equal to XX0001-XX0999, XX1200-XX1299, XX3025-XX3099, XX3300-XX3399, XX4000-XX4499,
-And-
The Statement From Date is on or after 01/01/2017,
-And-
For DDE claims: The address is present on MAP171F, Claim Page 03, and matches the address on the Provider Practice Query Screen, MAP1AB2. The Dates of Service (including the Statement from Date), are within the effective/termination date range listed on the Provider Practice Query Screen

For Hardcopy and EMC claims: The address is present on MAP103M, Claim Page 42, and matches the address on the Provider Practice Query Screen, MAP1AB2. The Dates of Service (including the Statement from Date), are within the effective/termination date range listed on the Provider Practice Query Screen.
-And-
The 603 PBD indicator is equal to Y and the 603 PBD Exception
field is equal to blank, 4, or 5,
-Or-
The 603 PBD indicator is equal to N and the Grandfathered PBD
Exception field is equal to blank or 4,
-And-
One or more line items present on the claim do not contain a PO modifier or a PN modifier.

Common Reason Code Errors

The provider number billed is deemed a provider-based location and should submit with the appropriate PO/PN modifier.

Common Reason Code Corrections

  • Ensure line item contains the appropriate PO/PN modifier.
  • 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.
  • If the provider-based status has changed, and the facility is no longer wholly owned and operated by a main facility, notify Noridian of this change in relationship.

Resource

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

Last Updated Mar 21, 2019