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Last Modified: 6/14/2022 Location: FL, PR, USVI Business: Part A

RTP reason code 30960 FAQ

Q: We are receiving a return to provider (RTP) reason code 30960, so what steps can we take to avoid this reason code?
You can refer to Part A reason code lookup for a description associated with the Medicare Part A reason code(s). Enter a valid reason code into the box and click the submit button.
A: You receive this reason code when you attempt to adjust a partially or fully medically approved claim. You're not permitted to adjust claims that are medically approved or denied.
Before you correct a claim, it is recommended that you review each line-item service billed to determine if it has been medically approved or denied.
Refer to the article "Identifying medically reviewed adjudicated claims," for additional instruction on claims reviewed based on medical policy and are either paid in full, partially paid, or totally denied
When the claim is within the timely filing limit, and there is a medically approved line item(s) present:
Cancel the original claim using type of bill (TOB) XX8
If for a simple change, billing issue or to add/delete line items
You're not permitted to cancel claims using direct data entry (DDE). You must cancel the claim through other electronic means or a hard copy (CMS-1450 form [UB-04]).
Resubmit a corrected claim once the canceled claim has finalized (should take approximately two days)
Add comments/remarks to the claim, must include all changes made
When the claim is beyond the timely filing limit, and a medically approved line item(s) present:
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 hard copy claims (CMS-1450 form [UB-04]). You must request the claim reopening via electronic media claims (EMC) or DDE.
Refer to MLN Matters article SE1426 external pdf file for additional guidance and coding instructions
If original claim does not include medically reviewed lines, DDE users can F9 claim to reprocess.
Please take a moment to visit our Adjust, reopen, or resubmit claim FAQs page for additional guidance and helpful information.
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.