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Published Date:12/16/2019

Printed Date: 9/22/2015

URL: http://palmgba.com/marlowe/redesign6/article.html

Reason Code 12811

Description
Occurrence code must be blank or a two-character code of: > 01-99 or A0-Z9 or AA-ZZ with a valid date.

Resolution

For occurrence code 21, the associated date cannot be after the claim "Through" date
For occurrence code 22, the associated date must be within the “From” and "Through" date of the claim, unless the claim has a non-payment code of C, N or W then the date can be prior to the “From” date
For occurrence codes 26, 32 or 42 the associated date must be within the “From” and "Through" date of the claim

Note: the fourth digit of the reason code indicates the position in which the error occurred. The sequence is 1-0 (0 denotes the tenth occurrence) and A-T (T denotes the thirtieth occurrence).

Resource
CMS Internet Only Manual (IOM), Publication 100-4, Medicare Claims Processing Manual.

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Last Updated: 12/16/2019

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