Last Modified: 4/30/2020
Location: FL, PR, USVI
Business: Part A
Q: We received a return to provider (RTP) with reason code 30940. What steps can we take to avoid this RTP reason code?
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.
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
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.
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