Top claims returned to provider, rejected, and denied
As claims process in the Fiscal Intermediary Standard System (FISS), the Medicare Part A claims processing system, they move through different claim statuses and locations. These claims statuses provide you with information about the claim and may indicate actions you need to take. The status codes are:
• S -- Suspended
• T – Returned to provider (RTP)
• R – Rejected
• D – Denied
• Claim medically denied due to LCD or NCD
• Redetermination is recommended
• P – Paid
combination with a status code the claim is assigned a reason code. The reason code
will provide you with an explanation and help you determine the actions you need to take to correct your claim(s).
Please review the FAQs and other resources listed below to avoid common denials and claims rejections. Billing Medicare correctly the first time increases your cash flow while reducing provider burden.
A claim on status T (RTP) was returned to provider for corrections. The assigned reason code will provide you instructions for the necessary corrections.
A status R claim is a claim that was rejected for reasons such as Medicare eligibility, billing issues like overlapping with another provider’s claim, Medicare Secondary Payer (MSP) provisions, duplicate claims or claims that failed the timeliness requirements.
A status D claim or line item is one that denied due to not meeting medical necessity requirements as outlined in an LCD or NCD.
Take advantage of these helpful resources and reference guides to help you bill better and prevent claims rejected and returned to provider.
First Coast offers providers the opportunity to enhance their Medicare knowledge through instructor-led training (ILT) classes (e.g., webcasts, seminars) and web-based training (WBT).
Check our upcoming provider events calendar
and learn how to register for free teleconferences and webcasts that will help you increase your knowledge of the Medicare program and find ways to improve Medicare billing and payment efficiency.
First Coast’s YouTube channel
will navigate you through Medicare requirements, simplify your day-to-day processes, and improve your billing.
Learning On Demand
The Learning on Demand Center
offers access to top requested educational videos, WBT, recordings, and tutorials. We invite you to browse these playlists and increase your Medicare knowledge.
First Coast University educational opportunities
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.