RTP reason code 34963 FAQ
Q. We are receiving a return to provider (RTP) reason code 34963. What steps can we take to avoid this reason code?
Refer to the Part A Reason Code Lookup for a description associated with the Medicare Part A reason code(s). Enter a valid reason code into the box and click the submit button.
A. Claims will return with reason code 34963 for one of the following reasons:
- The attending physician on claim page 03 is invalid
- The attending physician NPI is present, but the first four digits of the last name do not match PECOS
- The claim has a through date of service equal or greater than the termination date of the physician
Resolution
Validate the provider’s name in PECOS. Correct the reported physician information and resubmit.
If you don’t have PECOS access, you can use the order and referring data set at data.cms.gov to verify the physician’s name and spelling as seen in PECOS. It is recommended to search by the provider’s NPI to correctly display the information.
Example 1
- Provider’s NPI: XXXXXXXXX
- Provider’s name: John Smith
- System editing: J Smit
Example 2
- Provider’s NPI: XXXXXXXXX
- Provider’s name: John Smith Jones or Smith-Jones
- System editing: J Smit
Make sure billing staff reviews MLN Matter Article MM12889 New Fiscal Intermediary Shared System edit to validate attending provider NPI. Effective for claims received on or after April 1, there is a new consistency edit that validates the attending provider NPI. Organizational NPIs cannot be used in place of individual NPIs, unless exception conditions are met.