31094

FISS Narrative:

  • Total covered charges cannot be greater than zero if the third position of the type of bill (TOB) equals zero
  • Please verify the type of bill and/or the total covered charges reported, correct and resubmit/rekey. Hardcopy submitters resubmit RTP report with corrections.

Explanation and suggestion:

  • This reason code is received because the claim is billed with a zero (0) in the third position of the Type of Bill (TOB) indicating a no-pay and/or non-covered claim, but the charges on the claim are listed as covered charges
  • In some cases the type of bill may be reported incorrectly, if this is the case please update the TOB
  • If this is a no-pay and/or non-covered claim, the charges must be moved to the non-covered column

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