Description
This is an outpatient claim (Type of Bill 12X, 13X, or 14X) in which the Outpatient Prospective Payment System (OPPS) reimbursement is greater than the covered charges reported on the claim.

Resolution

  • Access the claim. The Remarks section will include the code(s) in question.
  • Verify the code(s), unit(s), and charges are reported correctly
  • If correct, indicate the following in Remarks and F9/resubmit the claim: code or codes have been verified
  • If any of the line item information was reported incorrectly, correct the information and F9/resubmit the claim

Reference: MLN Article 7771 (PDF, 87 KB). Prior to the initial submission of the claim, if providers are aware that the claim has a comprehensive APC that could be causing the reason code, they may indicate in Remarks that the charges have been verified. This will prevent the claim from RTPing with reason code 39132.

Contact Palmetto GBA JJ Part A Medicare

Provider Contact Center: 877-567-7271

Email JJ Part A

Contact a specific JJ Part A department


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