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Last Modified: 4/30/2020 Location: FL, PR, USVI Business: Part A

Avoiding RTP reason code 30940 FAQ

Q: We received a return to provider (RTP) with reason code 30940. What steps can we take to avoid this RTP reason code?
Click here for a description associated with Medicare Part A reason code(s). Enter the reason code into the box, and click the submit button.
A: You received this RTP, because you attempted to adjust a partially or fully medically denied claim. Claims that are medically approved or denied may not be adjusted.
Prior to correcting any claim, review each line item billed and determine if the service was medically approved or denied.
Refer to the article Identifying medically reviewed adjudicated claims for additional instructions on claims that are reviewed based on medical policy, and are paid in full, partially paid, or totally denied.
When the claim is within the timely filing limit, and there is a medically denied line item:
Cancel the original claim using type of bill (TOB) XX8
Must include remarks stating the reason why the claim needs to be canceled (e.g., cancelling due to billing error)
Must indicate if the claim is being cancelled due to a simple change, billing issue or to add/delete line items
You are not permitted to cancel a claim using direct data entry (DDE). You must cancel the claim through other electronic means or via hard copy (CMS-1450 form [UB-04]).
Resubmit a corrected claim after the canceled claim has finalized (should take approximately two days)
Add comments/remarks to the claim stating all changes that were made
When the claim is beyond the timely filing limit, and there is a medically denied line item:
Do not cancel and resubmit the claim
Request a claim reopening using TOB XXQ
If for a simple change, or billing issue
You are not permitted to submit TOB XXQ using a hard copy claim (CMS-1450 form [UB-04]). You must request the claim reopening via electronic media claim (EMC) or DDE.
Refer to MLN Matters® article SE1426 external pdf file for additional guidance and coding instructions
If the original claim does not include medically denied/reviewed lines, DDE users can F9 the claim to reprocess.
If you do not agree with the decision for the medically denied line(s) and are within the time limit, you may submit a first level of appeal-redetermination.
Please take a moment to visit our Adjust, reopen, or resubmit claim FAQs page for additional guidance and information.
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First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.