Return to Provider (RTP)
When a claim is submitted, it processes through a series of edits in the Fiscal Intermediary Standard System (FISS), to ensure the information submitted is complete and correct. If the claim has incomplete, incorrect or missing information, it will be sent to your return to provider (RTP) file. For example, if an invalid HCPCS code is submitted, the claim will be moved to the RTP file in status/location T B9997 for you to correct.
Electronic providers can access claims in the RTP file by using FISS, and are able to make the necessary corrections to the claim. The claim will remain in the RTP status/location T B9997 for up to thirty-six months. A new receipt date is assigned to a claim when it is moved out of the RTP file. Therefore, it is important to ensure that your billing transactions are corrected from RTP (T B9997) status/location) prior to the timely filing deadline. Refer to the Timely Claim Filing Requirements Web page for additional information. For hospice providers, if a Notice of Election (NOE) is sent to the RTP file, and is not corrected within 5 calendar days after the hospice admission date, it is considered untimely. Hospice providers can refer to the “Timeline for Submitting Notices of Election (NOEs)” information on the CGS website for additional information.
For assistance on how to access claims in RTP, and for detailed instructions about correcting claims in the RTP file, refer to the Claims Corrections(Chapter 5) of the FISS Guide.
Note for paper providers: If your agency meets the small provider exception to submit paper claims to CGS, and you do not have access to FISS, you will need to send in a new UB-04 claim form when your claim needs correction. To determine if your paper claims need correction, utilize the CGS Interactive Voice Response (IVR) system or the CGS web portal, myCGS. Refer to the IVR User Guideor the myCGS User Manual for additional information.
Providers should be aware that due to the large volume of edits, which Medicare claims may encounter while processing, claims may need correction more than one time, and for multiple reasons. Therefore, providers should verify that all required claim data is present, and that the information is complete and correct.
Refer to the Top Claim Submission Errors and How to Resolve Web page to review the top reason codes that cause billing transactions to either reject or need correction.
For assistance in submitting home health and hospice billing transactions and the data required, refer to the following:
The Educational Materials & Resource Web page also provides information that will assist in submitting complete and accurate claims.
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