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Last Modified: 8/6/2010
Location: FL, PR, USVI
Business: Part A
Top Part A returned to provider (RTP) claims
Below are the most frequent RTP reason codes and descriptions for claims processed by Medicare Part A during June 2010, as well as tips and resources to help you avoid many of these issues.
Please share this information with all who need to know, such as your IT staff, billing service, vendor, or clearinghouse. Remember, billing Medicare correctly the first time saves everyone time and money.
• Remember: Questions about claim status, patient eligibility (Medicare, MSP and Medicare Advantage [formerly Medicare HMO]), deductible information, and your financial information (last three checks, month/year to date dollar amounts) can be answered via direct data entry (DDE) 
or must go through the Interactive Voice Response system or IVR. Contact the Part A IVR by calling 1-877-602-8816. Refer to the Part A IVR Quick Reference Guide for instructions.
or must go through the Interactive Voice Response system or IVR. Contact the Part A IVR by calling 1-877-602-8816. Refer to the Part A IVR Quick Reference Guide for instructions.Note: Under current guidelines, any reference to "UPIN" within the definitions of codes should be interpreted as "NPI." The Centers for Medicare & Medicaid Services (CMS) are not responsible for updating denial codes, so some definitions may reflect outdated verbiage.
RTP reason codes, descriptions, and tips or frequently-asked questions (FAQs)
• 12101
• 19201
• 31256
• 32402
• 34924
• 34931
Did you know you can now create an account and receive your personalized Provider Data Summary (PDS) report?
The Provider Data Summary (PDS) is a comprehensive billing report designed to be utilized along with Medicare Remittance Notices (MRNs) and other provider-accessible billing resources to help identify potential Medicare billing issues through a detailed analysis of your personal billing patterns in comparison with those of similar providers. Use the PDS portal to request this useful report and enhance the accuracy and efficiency of your Medicare billing process.
Obtain your personalized PDS report by visiting our Provider Data Summary page. It is here you will find all PDS resources, including a guide, helpful FAQs, and the PDS Portal. Select the link titled "PDS Portal." From there, you will be given the option to log in, get help with a misplaced password, or create an account.
• Note: The PDS is currently not available for Puerto Rico and U.S. Virgin Islands providers. Please continue to monitor our website for release.
Source: FCSO Education Action Team
