30949

FISS Narrative:

  • For bill types 11X, 18X and 21X, the covered days (Fld 7) must equal the accommodation units (Fld 46) for revenue codes 10X through 21X 
  • Type of bill equals xx7 or xx8 but no condition code is present on the bill. Please include the appropriate condition code of:
    • D0 - Changes to service dates
    • D1 - Changes in charges
    • D2 - Changes in revenue code/HCPC
    • D3 - Second or subsequent interim PPS bill
    • D4 - Change in Grouper input (DRG)
    • D5 - Cancel only to correct a patient's Medicare ID number or provider number
    • D6 - Cancel only - duplicate payment, outpatient to inpatient overlap, OIG overpayment
    • D7 - Change to make Medicare secondary payer
    • D8 - Change to make Medicare primary payer
    • D9 - Any other changes
    • E0 - Change in patient status

Explanation and Suggestion
In this instance, the provider is submitting an adjustment (type of bill = xx7) or a paid claim cancellation (xx8), but they have failed to include the claim change condition code (FL 24-30) that explains the adjustment or cancellation.

  • Please add one of the 'condition codes' listed in the reason code narrative to your claim

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