Tips to prevent RTP 30960
You receive this reason code when you attempt to adjust a partially or fully medically approved claim. You're not permitted to adjust claims that are medically approved or denied.
Before you correct a claim, it is recommended that you review each line-item service billed to determine if it has been medically approved or denied.
- Review how to identify medically reviewed adjudicated claims (reason codes 30940 and 30941) for additional instruction on claims reviewed based on medical policy and are either paid in full, partially paid, or totally denied.
When the claim is within the timely filing limit, and there is a medically approved line item(s) present:
- Cancel the original claim using type of bill (TOB) XX8
- If for a simple change, billing issue or to add / delete line items
- You're not permitted to cancel claims using direct data entry (DDE). You must cancel the claim through other electronic means or a hard copy (CMS-1450 form [UB-04]).
- Resubmit a corrected claim once the canceled claim has finalized (should take approximately two days)
- Add comments / remarks to the claim, must include all changes made
When the claim is beyond the timely filing limit, and a medically approved line item(s) present:
- Do not cancel and resubmit the claim
- Request a claim reopening using TOB XXQ
- If for a simple change, or billing issue
- You are not permitted to submit TOB XXQ using hard copy claims (CMS-1450 form [UB-04]). You must request the claim reopening via electronic media claims (EMC) or DDE.
If original claim does not include medically reviewed lines, DDE users can F9 claim to reprocess.
Please take a moment to visit our Claims: Adjusting, reopening, cancelling, and resubmitting page for additional guidance and helpful information.
You can refer to Part A Reason Code Lookup Tool 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.
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