Reason Code 37538

Reason Code Narrative

UB92 PROVIDER SUBMITTED ADJUSTMENT (XX7) IS MAKING A LINE ITEM COVERED THAT WAS NONCOVERED ON ORIGINAL CLAIM. SAME REVENUE CODE ON BOTH CLAIMS WITH COVERED CHARGES ON ADJUSTMENT, BUT NON COVERED CHARGES ON ORIGINAL.

Common Reason Code Errors

  • A non-covered line on original claim is being moved to covered on an adjustment and claim change condition code D1 is not being billed
  • A claim change condition code  is billed but a more appropriate "D" condition code is available

Common Reason Code Corrections

  • Changes made to covered charges need to be billed with a D1 claim change condition code

Resource

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Last Updated May 22, 2018