General

1. How does a provider request to have a suspended claim sent to the Return to Provider (RTP)?
2. My claim was returned with reason code 12302. How do I correct this?
3. My claim was sent to the RTP file indicating I need to add occurrence code 47 and the date the claim reached the PPS dollar threshold amount. How can I find the PPS dollar threshold amount?

1. How does a provider request to have a suspended claim sent to the Return to Provider (RTP)?

   The Customer Service Representatives can RTP the suspended claim for correction, if appropriate. Please call 1-877-235-8048 for assistance.

   (Question based on July & August 2008 top phone inquiries)

   Date Posted: 09/11/2008, Date Reviewed/Revised: 10/29/2008

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2. My claim was returned with reason code 12302. How do I correct this?

   When you receive this reason code, you need to verify the covered days billed on claim page 1 and the covered units billed on claim page 2.  If you are using a patient status code 30, you need to add one day to the calculation of covered days. 

   (Question based on July 2008 top phone inquiries)

   Date Posted: 09/11/2008, Date Reviewed/Revised: 10/29/2008

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3. My claim was sent to the RTP file indicating I need to add occurrence code 47 and the date the claim reached the PPS dollar threshold amount. How can I find the PPS dollar threshold amount?

   When your claim is on the RTP file, the PPS dollar threshold will be located on FISS claim page 6 under the heading 'outlier amount.'  This instruction can be found in the FISS Training Guide.

   (Question based on August 2008 top phone inquiries)

   Date Posted: 10/15/2008, Date Reviewed/Revised: 10/29/2008

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