Important Updates Concerning all Part A Services

The following issues have been added to the “Part A Claims Processing/Payment Issues” on the Reports Web page. This site will be updated when new information is received or a resolution implemented. Providers are encouraged to F9 affected claims in RTP status so they will suspend in the applicable locations until a system correction is received.

• Reason Code 17801: Claims receiving this reason code are editing incorrectly for invalid diagnosis or procedure code. These claims will suspend to location SM30PA. There is a workaround to correct claims receiving this reason code. Providers can correct affected claims in RTP status by removing the POA indicator in the 10th diagnosis code field and pressing F9.
• Reason Codes 34919, 34929 and 34931: Claims receiving these reason codes are editing in error and are related to the Present on Admission (POA) indicator. Claims will suspend in location SM30PA. This is a national issue and has been reported to the FISS maintainer for research.
• Reason Code 34929 Education Note: For 5010 implementation, Inpatient Prospective Payment System (IPPS) hospitals will no longer report the POA indicator of “1.” For Calendar Year (CY) 2011, a POA indicator of “1” cannot be submitted via Direct Data Entry (DDE). A hospital that needs to correct a claim via DDE that included a POA of “1” and was submitted prior to January 1, 2011, will need to submit an 837i or a new DDE claim. Note: The POA indicator “1” is still valid on 4010A1 claims. Refer to MLN Matters® article MM7024 for more information.
• Reason Code 31608: This code is editing in error indicating there is Health Maintenance Organization (HMO) involvement coding on the claim when there is not. This is a national issue and has been reported to the FISS maintainer for research. Affected claims will suspend to location SMFPL2.
• Reason Code 36111 or 36222: End Stage Renal Disease (ESRD) claims are editing in error (Return to Provider (RTP)) with reason code 36111 or 36222 for no Method 1 or Method 2 on file for home dialysis patients prior to January 1, 2011; however, there is a method selection on file. Affected claims will suspend to location SMFPL3. Note: For some providers, claims were rejecting prior to entering the Medicare claims processing system. These claims will now be accepted. This is a national issue and has been reported to the FISS maintainer for research.