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June 15, 2016

Save Time and Money! Submit Claims Correctly the First Time.

The top reason codes:

Top RTP - 32402

Top Reject – U5233

Indicates that the HCPCS was not billed with a valid revenue code for a date of service. HCPCS describe the service being billed and certain HCPCS are only paid in certain settings indicated by the revenue code.

If there is no revenue code listed in the revenue code field of the screen, the HCPCS can usually be billed with most allowable revenue codes. 

Instructions on finding allowable revenue codes for certain HCPCS can be located in the DDE/FISS User Manual - Chapter 3 - Inquiry MenuPDF.

Indicates that no Medicare payment can be made because the services on the claim fall within or overlap a Medicare Advantage (MA) or Health Maintenance Organization (HMO) enrollment period.

The CWF should be accessed prior to submission of every claim. If there is an open MA/HMO record for the date of service being billed, the claim should be billed to the MA/HMO.

Applicable MA/HMO information for each beneficiary can be accessed through the IVR, 270/271 eligibility transaction, HIQA, ELGA, or the myCGS Portal.

Be sure to review the complete list of the Top Billing Errors on our website.

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