Description
Claim with pass-through or non-pass-through drug or biological lacks OPPS payable procedure.

Resolution
Claims receiving this reason code in error were suspended until the January 2017 Integrated Outpatient Code Editor (IOCE) was implemented.

If there are claims that are RTP'd in error, F9 and resubmit, and claims will be suspended until the correction is implemented.

Note: There was an additional issue with W7099 editing incorrectly on non-OPPS claims. CMS and FISS have provided a work around for this issue. If you have claims RTP'd in error, F9 those claims for the work around to be applied.

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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