Last Modified: 6/14/2022
Location: FL, PR, USVI
Business: Part A
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.
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
for additional guidance and coding instructions
If original claim does not include medically reviewed lines, DDE users can F9 claim to reprocess.
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.