Guidance for Claims Returned to the Provider (RTP)

Published 01/30/2018

The Palmetto GBA Provider Contact Center is receiving a high volume of calls regarding the following concerns:

  • JJ Part A providers that receive a claim returned to the provider (RTP) with no reason code verbiage may return (F9) the claim back into the processing system so we may process with applicable reason code. This issue should only occur on reason codes in the 5 and 7 series where we did not rollover the previous contractor codes. 
  • Do NOT use “Remarks” to indicate usage of Lifetime Reserve Days. To indicate that the beneficiary does or does not wish to utilize their lifetime reserve days, adhere a condition code 67 or 68 when submitting the claim. Remarks are not necessary.

Reason Code 31090
FISS Narrative
On an inpatient or SNF claim, the covered day count is equal to zero, but covered charges are greater than zero.

Explanation and Suggestion
Reason Code 31090 indicates that on an inpatient or Skilled Nursing Facility claim, the covered day count = zero, but total covered charges are greater than zero. Providers should be aware as to when to use occurrence span code (OSC) M1 versus OSC 77.

  • Occurrence Span Code M1: Provider Liability – No Utilization
    The From/Through dates of a period of non-covered care that is denied due to lack of medical necessity or as custodial care for which the provider is liable. The beneficiary is not charged with utilization. The provider may not collect Part A or Part B deductible or coinsurance from the beneficiary. Please refer to the revised MLN Matters® Number: SE1333 (PDF, 116 KB).
  • Occurrence Span Code 77: Provider Liability – Utilization Charged
    The From/Through dates for a period of non-covered care for which the provider is liable (other than for lack of medical necessity or as custodial care). The beneficiary’s record is charged with Part A days, Part A or Part B deductible, and Part B coinsurance. The provider may collect Part A or Part B deductible and coinsurance from the beneficiary. Please refer to CMS IOM 100-4, Chapter 3, (PDF, 2 MB) Section 40.1, F. Provider Liability Issues.

Reason Code 32901
FISS Narrative
For UB04 claims, the transaction type is D (debit), but the adjustment reason code is not valid.
                
Explanation and Suggestion
Reason Code 32901 edits when an adjustment is submitted, however, the adjustment reason code is either missing or invalid.  Valid values for the adjustment reason code are: AM, AR, AU, AW, BL, CA, CD, CO, CP, CW, DA, DC, DD, DO, DP, DS, DV, DW, ES, HD, HP, IC, ID, JP, KD, KP, LD, LI, LW, MC, OD, OP, OT, PC, PD, PF, PN, PW, R1, R2, R3, RC, RI, RP, SB, SD, SW, TD, TL, TW, VA, WC, WE, YA, YB, YC, YD. Please make corrections and resubmit.

Reason Code 32206
FISS Narrative

The revenue code billed is invalid for this type of bill. Please make corrections and resubmit your claim.

Explanation and Suggestion
Ensure billing correct revenue code for type of bill (TOB). Make corrections and resubmit your claim.

Attention! Religious Nonmedical Health Care Institutions (RNHCI), revenue code 0120 has been added for 41X TOBs. Please return (F9) these claims to continue to process.