Top Part A return to provider (RTP) claims

Home

Inquiries and denials

Last Modified: 2/9/2012 Location: FL, PR, USVI Business: Part A

Top Part A returned to provider (RTP) claims

Below are the most frequent RTP reason codes for claims processed by Medicare Part A during December 2011, 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.

• Click here for general Part A inquiries (e.g., claims, eligibility information).

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for Medicare & Medicaid Services (CMS) are not responsible for updating denial codes, so some definitions may reflect outdated verbiage.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)

• 10419

• 11701

• 12206

• 14303

• 31313

• 31587

• 31608

• 32061

• 32200

• 32206

• 32400

• 32402

• 32404

• 34931

• 38038

• 38119

• N5052

• W7006

• Other common tips on inquiries, rejects and RTPs -- click here

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.

Source: FCSO Education Action Team