Top Claim Submission Errors and How to Resolve
Through data analysis, we have identified the top claim submission errors (CSEs) for the quarter ending March 31, 2007. CSEs cause your billing transactions to either reject or move to your Return to Provider (RTP) file for correction, and create unnecessary costs to the Medicare program. Remember that it is your responsibility as a Medicare provider to ensure the information submitted on your billing transactions is correct and compliant with Medicare regulations.
Below is a list of the top errors by reason code, which provider type the errors apply to, and resources you can use to avoid future billing errors. Please take time to review these and share them with your staff.
| Reason Code | Reason for Error | Provider Type Affected | Resources for Prevention/Resolution |
|---|---|---|---|
| 30715 (RTP) | Beneficiary’s name (first, last or middle) does not match the FISS eligibility record. | All Providers |
|
| 38200, 38050 and 38157 (Reject) | Duplicate RAP/claim submitted. | All Providers | |
| C7010 (Reject) | Beneficiary has elected the Medicare hospice benefit and services billed as being related to the terminal diagnosis | All Providers (except hospice) |
|
| U5233 (Reject) | Dates of service billed are within a beneficiary Medicare Advantage (MA) plan election; therefore, no Medicare payment can be made. | All Providers (except hospice) |
Page last updated: May 31, 2007
