This reason code is assigned when an adjustment claim (type of bill XX7) was submitted with an incorrect cross-reference document control number (DCN), or you are attempting to adjust a previously adjusted / cancelled DCN. The following actions should be taken prior to submitting an adjusted claim.

• Ensure the cross reference DCN is correct and complete for the claim being adjusted
  • CMS-1450, field locator (FL) 64 or electronic equivalent
  • Direct data entry (DDE) claims screen page 01, MAP1711
• Submit a new claim if the original claim has been cancelled (type of bill XX8)
• Submit an adjusted claim if the original claim has been adjusted (type of bill XX7)
• For additional information, view our Claims adjusting, reopening, and resubmitting article.

For a description associated with Medicare Part A reason code(s) visit Part A Reason Code Lookup Tool. Enter a valid reason code into the box and click the submit button.

References

• CMS IOM Pub. 100-04, Chapter 34
• CMS Medicare Learning Network (MLN) fact sheet - Medicare billing: 837I and CMS-1450
• Medicare Part A direct data entry (DDE) training manual