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There could be several reasons why your claim was denied or otherwise did not process successfully. Use these available resources to identify claims processing codes.
Payment for ambulatory surgical centers (ASCs) are made under a separate payment system. As such, certain modifiers are specific to ASCs. This article explores these modifiers.
Review this article if your claim is returning for reason code 326x4.
Read this article for tips on how to prevent RTP 12206.
Read this article for tips on how to prevent RTP 30949.
Read this article for tips on how to prevent reject reason code 76474.
Read this article to learn more about submitting high dollar claims for single use vials.
These tables display processing issues that are being worked currently or have been resolved recently.
Breaking news for critical access hospitals (CAHs): CMS has directed MACs to immediately turn off reason codes 31006 and 31007 to give providers time to submit all method II reassignments to their Part A CAHs promptly. Read further to learn…
CAH Part A Method II claims for professional services will return to provider (RTP) if a reassignment isn’t in PECOS. Watch the on-demand learning video, "CAHs Method II Professional Reassignments," for instructions to add reassignments.