Reason Code 31947

Description
This claim line was submitted by the provider as non-covered. Providers are liable for these denials unless a specific modifier or indicator (i.e., occurrence code 32) on the claim attaches liability to the beneficiary.

Resolution
This is a valid processing reason code. It does not reflect incorrect billing. Condition code (CC) 20, 21 or occurrence code (OC) 32 is not present on the claim to indicate the non-covered reason.

  • OC 32 = Advance Beneficiary Notice (ABN) given; report with appropriate liability-related modifier and covered charges
  • CC 20 = Demand bill will be reviewed
  • CC 21 = No-payment, automatically process

Resource
CMS Internet Only Manual (IOM), Publication 100-04, chapter 1 (PDF, 1.62 MB), section 60.4.2.