Production Alert Details

Part A Claims RTP RC 38361

Date Reported:
Date Updated:
Date Resolved:
Provider Types Impacted:

Jurisdiction 6 and Jurisdiction K Part A Providers

Reason Code(s):
Claim Coding Impact:

Description of Issue

Claims are continuing to incorrectly RTP even when the prior claims are not No Pay Claims.

National Government Services Action

Edit 38361 has been updated to no longer assign when prior rejected claims (TOB 210) with same admit date have already processed. However, this edit will continue to assign on SNF COVID  100 claims.

Provider Action

If a claim incorrectly assigned 38361, the provider can F9 the claim to process.  If a claim correctly assigned 38361, the provider should update the admission date.  
If claims have returned to the provider with edit 38361 and are related to COVID 100, the provider will need to call National Government Services' Customer Care to have the claim(s) manually corrected.


Proposed Resolution/Fix

Fix implemented 8/30/2023