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Printed Date: 9/22/2015
A provider is not permitted to adjust a partially or fully medically denied claim. Reason code 30940 is received when attempting to adjust a claim with a medically denied line. If you are trying to add diagnosis codes, change CPT codes or move denied charges from non-covered to covered, you must submit a redetermination.
Explanation and Suggestion:
There is a medically denied line on the original claim and the provider is attempting to submit an adjustment making changes to a medically denied line or a medically denied line is being removed from the claim.
If claim contains a medically denied line, the only allowed changes are:
If original claim does not include medically denied/reviewed lines, Direct Data Entry (DDE) users may F9 claim to reprocess.
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Last Updated: 12/27/2018