Last Modified: 10/8/2009
Location: FL, PR, USVI
Business: Part A
This claim has rejected due to all line items have rejected and/or rejected and denied. Review each line item to identify the applicable line edit, and utilize the reason code narratives to identify possible billing error(s). If the primary procedure line is not payable due to an edit assigned, then all incidental lines on the same date of service will not be payable due to other related edits.
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If an adjustment needs to be submitted to correct billing error(s) on a rejected line item, then each applicable line item will need to be deleted and re-keyed in its entirety in order for the previous edit to be deleted.
Also, remember incidental lines will need to be deleted and re-keyed.
Tips
There are several ways you can review the claim and see the line item reason code:
• DDE users -- open the claim and go to page 2, press the PF2 key and this will take you to the breakdown for the line items. You will see page MAP171D (in the top left corner of the page). On this page you will look at the bottom for the line item reason code. Once you have this reason code, you can PF1 and key the number in the reason code field to pull the description.
• If the claim is in a rejected status, you may adjust the claim, fix the line item, and resubmit.
• If the claim is in a denied status, you may not adjust a denied line item. You must go through the appeals process. For more information regarding appeals, visit
www.fcsomedicaretraining.com 
• Review the 201 report through DDE for history of the claims submitted.
Review the remittance advice to obtain a history of claims submitted.
Source: FCSO Education Action Team
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