Reason Code 12206

Description
The sum of covered days and non-covered days must equal the statement covers period. When the "from" and "through" dates are not the same on an inpatient or Skilled Nursing Facility (SNF) bill types, the number of days represented must equal the sum of the covered days plus the non-covered days, unless the patient status is 30. If the patient status is 30, one additional day is used in the calculation.

Resolution
Verify billing, and if appropriate correct the claim or resubmit.

  • This reason code indicates the number of days represented by the "from" and "through" dates on the claim have not been counted correctly
  • Frequently this count is incorrect by one day based upon whether the patient status code is a discharge status or still patient (code 30)
  • If the patient status code is a discharge status, the through date is not included in the count
  • If the patient status code is still patient (30), the through date is added to the count of total days

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