Return to Provider code 30912, 30949 and 153xx - Part A rejction codes

Q: What steps can we take to avoid return to provider (RTP) reason code 30912?

A: An adjustment claim (type of bill XX7) was submitted with an incorrect cross-reference document control number (DCN), or you are attempting to adjust a previously adjusted/cancelled DCN. The following actions should be taken prior to submitting an adjusted claim:
• Ensure the cross reference DCN is correct and complete for the claim being adjusted
• Centers for Medicare & Medicaid Services (CMS) form 1450, field locator (FL) 64 or electronic equivalent
• Direct Data Entry (DDE) claim screen page 01, MAP1711
• Submit a new claim if the original claim has been cancelled (type of bill XX8)
• Submit an adjusted claim if the original claim has been adjusted (type of bill XX7)

Q: We are receiving a return to provider (RTP) reason code 30949, so what steps can we take to avoid this reason code?

A: You are receiving this reason code when the type of bill (TOB) equals xx7 or xx8, but the claim change reason ‘condition code’ is not present on the bill.
Condition codes:
• D0 - Changes to service dates
• D1 - Changes in charges
• D2 - Changes in revenue code/HCPC
• D3 - Second or subsequent interim PPS bill
• D4 - Change in Grouper input (DRG)
• D5 - Cancel only to correct a HIC or provider number
• D6 - Cancel only - duplicate payment, outpatient to inpatient overlap, OIG overpayment
• D7 - Change to make Medicare secondary payer
• D8 - Change to make Medicare primary payer
• D9 - Any other changes
• E0 - Change in patient status
Please add the appropriate condition code listed above in the reason code narrative to correct your claim(s) and resubmit

Q: What steps can we take to avoid return to provider (RTP) reason code(s) 153XX-154XX?
A: Claims that RTP with reason codes 153XX-154XX indicate that the total charges revenue line 0001 contains a charge not equal to the sum total of all line items billed (covered and non-covered) on the claim.
There may have been updates or changes to some of the line items billed, but the total charge line was not deleted and re-entered with the correct amount.
To avoid this reason code from recurring, the following steps should be taken prior to updating the claim:
• Verify total charges for all line items billed (covered and non-covered)
• Delete revenue code line 0001 and re-key calculated charges