Reason Code 34923
This error is caused by one or more of the following:
- A revenue code line contains a service date that is within the occurrence span code (OSC) 77 dates, but the units and/or charges appear as covered;
- A revenue code line contains noncovered units or charges, but the service date is outside of the OSC 77 dates;
- The total noncovered days do not equal the total noncovered days indicated by OSC 77
FISS Claim Page 01 includes an OSC 77 with 1002YY–1004YY. On FISS Claim Page 02, the revenue code lines for dates of service 1002YY–1004YY appropriately report noncovered charges (NCOV CHARGE), however, the units are reported as covered (COV UNIT). This is causing RC 34923 to fire.
Currently, providers that submit claims electronically, via the ANSI X12N version 5010, do not have a way to report noncovered units. As a result, FISS is incorrectly plugging covered units in the “COV UNIT” field, despite noncovered charges being reported. Providers experiencing errors for this reason may either submit the claim via Direct Data Entry (using FISS) to accurately report the units as noncovered, or if the claim is submitted electronically, it must be corrected from their Return to Provider (RTP) file once the reason code 34923 is applied.
How to Prevent or Resolve This Issue
When reporting an OSC 77 (untimely NOE or untimely recertification), verify that the units and charges are reported as noncovered (i.e. the “COV UNIT” field does not include any units) on the revenue code lines associated with the OSC 77 dates.
If the units were incorrectly entered as covered, you must delete and rekey each revenue code line where the units were reported incorrectly. Follow the steps below to resolve this error.
- Access the claim from the RTP file — DDE Claims Correction
- Go to FISS Page 02
- Key a "D" over the first digit of the revenue code for each line you are deleting (those lines where the “SERV DATE” falls within the OSC 77 dates)
- Press the Home key, then Enter. The revenue code lines in which the "D" was entered will be deleted.
- Re-key the revenue code lines, ensuring that the “COV UNIT” field is blank for the noncovered lines, and charges are reported as noncovered (NCOV CHARGE)