Medicare common EDI denial and action.

NPI # - Invalid


Reason for denial - When the NPI reported for the Billing/Pay-to provider is not the NPI on the Medicare NPI crosswalk, the file rejects.

How to resolve - Confirm the correct NPI is reported for the Billing/Pay-to provider. Technically Speaking Report the NPI in the 2010AA NM109.


OTH DIAG Code Invalid


Reason for denial - When the diagnosis code reported for the condition that is present with the principle diagnosis is not a valid diagnosis code or the code is not valid for the procedure code reported, the claim rejects.




How to resolve the denial - Confirm the diagnosis code is valid for the dates reported and the procedure
code reported.Technically Speaking Report the other diagnosis code in 2300 HI segment


Admit DIAG code invalid


Reason for denial - When an invalid admission diagnosis code is reported that is not valid for the dates of service, the procedure code or both, the claim rejects

How to resolve the denial - Confirm the diagnosis code is valid for the dates reported and the procedure code reported. Technically Speaking Report the corrected admission diagnosis code in 2300HI segment.


  DISCHRG HOUR QL Required for Final TOB


Reason for Denial - When the discharge hour is not reported on the final bill for inpatient claims, the claim
rejects.

How to resolve the denial - Confirm the discharge hour is reported in military time for the final bill for inpatient claims.Technically Speaking Report the discharge hour in the 2300 DTP03 segment


M381 Invalid TIN vs NPI


Reason for Denial - The tax identification number (TIN) reported for the rendering provider does not match the National Provider Identification (NPI) on the crosswalk file.

How to resolve the denial - Confirm the tax identification number for the rendering provider matches the National Provider Identifier information at the NPPES Web site.Technically Speaking Report the EIN or SSN in 2310B REF02.

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