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FISS/DDE Provider Online Guide: Chapter VII


About the 050 Claims Returned to Provider

Description

This is a listing by provider of claims in RTP status. The claims on the report are in status/location TB9997. The daily report will be available online for five days.

Report Purpose

To provide a listing of claims that are being RTP for correction. This report will be used by providers to identify the reason code(s) for the returned claims.

Sample 050 Claims Return to Provider (RTP) Report - Left view of the 050 RTP report. Identifies a listing of claims RTP, including claim details and reasons for RTP.

The right view of this screen can be accessed by using the <PF11/F11> key on your keyboard. Note the verticle line indicating where the screen has been split.

Sample 050 Claims Return to Provider (RTP) Report - Right view of the 050 RTP report. Identifies a listing of claims RTP, including claim details and reasons for RTP.

Use the <PF6/F6> key to scroll down to view the rest of the reason code narrative and/or to access the next claim in the report. At the end of the report, a total of RTP claims and Total Charges are listed.

Sample 050 Claims Return to Provider (RTP) Report - Left view, bottom of the 050 RTP report. Identifies a total of claims RTP.

Use the <PF11/F11> key to view the right view of this screen.

Sample 050 Claims Return to Provider (RTP) Report - Right view, bottom of the 050 RTP report. Identifies a total of claims RTP.

The following chart describes the various fields/report headings contained within the Claims Returned to Provider 050 report.

Field/Report Description
REPORT Identifies the report number (050)
FREQUENCY Identifies the report frequency (D = daily, W = weekly)
SCROLL Identifies the direction where more information can be accessed using the <PF10/F10> and <PF11/F11> keys (L = left, R = right)
KEY Identifies the provider number, can be overkeyed to display other provider information
PAGE Identifies the report page
SEARCH Function not used at this time
REPORT Identifies the report number (050)
SUBMITTER Internal user ID
CYCLE DATE Date of report
PROVIDER Provider number – Displays the identification number of the institution who rendered services to a particular beneficiary/patient, assigned by Medicare (13-position alphanumeric field)
NPI National Provider Identifier
FOR CYCLE DATE Date of report
FREQUENCY Frequency of report
RUN TIME Time report was generated
FOR PROVIDER Provider's name and address. This information is taken form the provider file. This field contains four lines and each line consists of 31 alphanumeric positions.
MID/CERT/SSNO Medicare Identification number – Identifies the Medicare idenfication number submitted by the provider for the beneficiary (twelve-position alphanumeric field)
PCN/DCN Patient/Document control number – Displays the identification number for a claim (23-position alphanumeric field)
TYPE BILL Type of bill – Identifies the type of facility, bill classification, and frequency of the claim in a particular period of care (3-position alphanumeric field)
PROVIDER/NPI Provider number – Displays the identification number of the facility listed on the claim (13-position alphanumeric field); NPI – National Provider Identifier
NAME Beneficiary name – Lists the last and first name as submitted by the provider of the patient who received the services (31-position alphanumeric field)
ADMIT Admit date – Identifies the date the beneficiary was admitted for inpatient services or the beginning of the outpatient, home health, or hospice services (six-position alphanumeric field in MMDDYY format)
COV FM Covered from date – Identifies the beginning date of services rendered to the beneficiary as indicated on the claim (six position-alphanumeric field in MMDDYY format)
COV TO Covered to date – Identifies the last date of services rendered to the beneficiary as indicated on the claim (six-position alphanumeric field in MMDDYY format)
TOTAL CHGS Total charges – Identifies the total charges as submitted by the provider (nine-digit field in 9,999,999.99 format)
NO TITLE Reason code – Identifies the reason code(s) assigned to the returned claim (five-position alphanumeric field)
NO TITLE Reason code narrative – Identifies the reason code(s) narrative for the returned claim (77-position alphanumeric field with a maximum of 150 occurrences for each reason code/narrative)
TOTAL RETURNED CLAIMS On last page of report This is the total number of reported RTP claims (seven-digit field in 9,999,999 format)
TOTAL RETURNED CHARGES On last page of report – This is the total amount of charges for reported RTP claims (11-digit field in 999,999,999.99 format)
FISS/DDE Provider Online Guide: Chapter VII - About the 050 Claims Returned to Provider
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