Reason Code 34977
Published 08/09/2023
Description
The claim has been returned to the provider (RTP) due to the address submitted on the claim is not an exact match to what is entered in the Provider Enrollment Chain and Ownership System (PECOS).
The claim has been returned to the provider (RTP) due to the address submitted on the claim is not an exact match to what is entered in the Provider Enrollment Chain and Ownership System (PECOS).
The Reason Code Assigns When:
The Type of Bill (TOB) is equal to 13X or 14X, the provider PTAN range is equal to XX0001–XX0999, XX1200–XX1299, XX3025–XX3099, XX3300–XX3399 or XX4000–XX4499, and the address is present on MAP171F, claim page 03, (for DDE claims) and does not match the address with EFF/TERM date range (including statement FROM date of claim) on the Provider Practice Address Query Screen (MAP1AB2).
Resolution
The Type of Bill (TOB) is equal to 13X or 14X, the provider PTAN range is equal to XX0001–XX0999, XX1200–XX1299, XX3025–XX3099, XX3300–XX3399 or XX4000–XX4499, and the address is present on MAP171F, claim page 03, (for DDE claims) and does not match the address with EFF/TERM date range (including statement FROM date of claim) on the Provider Practice Address Query Screen (MAP1AB2).
Resolution
- Validate address submitted on claim and ensure it’s an exact match to what is entered in PECOS
- Direct Data Entry (DDE) users
- Go to page three of any claims menu and press F11 twice to access MAP171F
- Enter practice address found in Section 3: Inquiries; 3.Q. Provider Practice Address Query Summary (PDF), Option 1D , MAP1AB1
- 1D screen displays the address as found in PECOS
- Each character, even if it's a space, is considered in system match
- Line items must match up. Example: if a suite number is on address line 2 in PECOS, it cannot be on line 3 of claim submission.
- Abbreviations must match. Example: if PECOS has "St" and claim is submitted with "Street," this will cause edit to assign.
- Direct Data Entry (DDE) users
- If the address is an off-campus provider-based location, has not been entered on the 855A, and the facility has not been deemed grandfathered, the address must be added to the 855A via PECOS
- To add a new or correct an existing practice location address, submit the CMS-855A enrollment form in PECOS
- Or, verify the address format in PECOS, DDE, or the eServices Portal, and ensure the service facility address on the claim is an exact match, and resubmit the claim
- For assistance in updating the address location, please view PECOS Enrollment Tutorial — Initial Enrollment for an Organization/Supplier — CMSHHS gov YouTube
Reference
- 42 Code of Federal Regulations (CFR) 413.65
- Medicare Learning Network (MLN) Matters (MM) 9613 (PDF)
- MM 9907 (PDF)
- Section 1833 (t)(21)(B)(iv)(II) of the Social Security Act
- Special Edition (SE) 18023 (PDF)
- CMS MLN Matters article SE19007 (PDF)