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Last Modified: 12/9/2011
Location: FL, PR, USVI
Business: Part A
12101
Patient status edit will apply:
If the type of bill (TOB) is equal to 11x, 21x, 32x, 33x, 41x, 51x, 18x, 28x and patient status is not numeric or not equal to 01 through 09, 20, 21, 30, 43, 50, 51, 61, 62, 63, 64, 65, 66, 70, 71 or 72.
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If TOB is equal to 81x, or 82x and patient status is not numeric or not equal to 01 through 09, 20, 21, 30, 40, 41, 43, 50, 51, 62, 63, 64, 66, 70, 71 or 72.
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If TOB is equal to 13x, 23x, 43x, or 83x and the statement covers 'from' date is 03/01/91 or greater and the patient status is not numeric or not equal to 01 through 09, 20, 21, 30, 43, 50, 51, 61, 62, 63, 64, 66, 70, 71, or 72.
If TOB is equal to 85x and the statement covers 'from' date is on or after 07/29/94 and the patient status is not numeric or equal to 01 through 09, 20, 21, 30, 43, 50, 51, 61, 62, 63, 64, 66, 70, 71, or 72.
***
If TOB is equal to 23x or 34x and the statement covers 'from' date is 04/01/2004 or greater and the patient status is not numeric or not equal to 01 through 09, 20, 21, 30, 43, 50, 51, 61, 62, 63, 64, 65, 66, 70, 71 or 72.
***
If TOB is equal to 81x or 82x and the statement covers 'from' date is 04/01/2004 or greater and the patient status is not numeric or not equal to 01 through 09, 20, 21, 30, 40, 41, 43, 50, 51, 61, 62, 63, 64, 65, 66, 70, 71 or 72.
***
For bill types 12x and 22x, patient status is required for claims with receipt date of 7/1/04 or greater.
Resources/tips to avoid or correct this return to provider (RTP) claim
This reason code occurs when information in the 'patient status field' on the claim is either invalid or missing. This often occurs due to a clerical error:
• The patient status code is missing; or
• The code entered is not valid for the TOB on the claim.
Steps you can take to correct this RTP:
1. Verify patient status code with information identified in medical records.
2. Research the claim to determine the appropriate patient status code for the type of bill.
3. Research to determine if the two digit patient status is incorrect or missing.
4. Correct the claim
, make the correction and PF9 the claim.• Correct the electronic claim and resubmit.
You can find patient status codes listed in the article "Clarification of Patient Discharge Status Codes and Hospital Transfer Policies" on page 32 of the February 2008 Medicare A Bulletin 
. Updated code information can also be found on the National Uniform Billing Committee's (NUBC) website (www.nubc.org 
) in the Official UB-04 Data Specifications Manual.
. Updated code information can also be found on the National Uniform Billing Committee's (NUBC) website (www.nubc.org ) in the Official UB-04 Data Specifications Manual.
Please use your browser's back button to return to the referring page.Source: FCSO Education Action Team
