Home Health & Hospice Week
Make Sure Your Claims Don't Include These Value Codes
If you’re receiving returned claims with reason code 10405, you may be stuck for a bit.
Problem: Some home health billing transactions are in the return to provider (RTP) file with reason code 10405. “This reason code appears when value codes QN – QW display on the billing transaction,” HHH Medicare Administrative Contractor CGS explains on its website.
Further problem: “Some of those claims are now suspended in status/location S MTECH,” CGS continues. “No provider action can be taken while the claim is suspended in this status/location.”
Solution: “CGS staff is working to move those billing transactions into the RTP file to allow providers to make the necessary correction,” the MAC says. “Once in RTP status/location T B9997, providers may delete the QN – QW value codes and the zero amounts and press F9 to allow processing to continue.”
Further solution: “If you have billing transactions with reason code 10405, please contact your billing software vendor so that value codes QN-QW are not submitted,” CGS adds. “Value codes QN-QW are for payer use only and should not be submitted by providers.”
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