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MIR-2007-05A, May 2007
Quick Tip: Verifying Operating Physician’s Unique Physician Identification Number (UPIN) or National Provider Identifier (NPI) and Name to Prevent Reason Code 19301
Claims are being returned to providers (RTP) when there is a principle procedure on an inpatient claim (11X type of bill), or a surgical revenue code and surgical HCPCS code on an outpatient claim (13X type of bill), and the operating physician name is missing.
Correcting an RTP for Reason Code 19301
- Verify the procedure codes on the inpatient claim.
- Verify the revenue and Healthcare Common Procedural Coding System (HCPCS) code on the outpatient claim.
- If surgery was cancelled, enter diagnosis code V641, V642, or V643 on the claim.
- Verify UPIN or NPI, and physician’s name on the claim.
- Make all of the appropriate corrections and resubmit the claim.
Preventing Reason Code 19301
To prevent reason code 19301 from occurring, set up your internal billing system or inform your billing service that when a surgical procedure is entered on the claim, the operating physician UPIN or NPI, and the physician’s name should be included on the claim. (The physician NPI is scheduled to replace the UPIN beginning May 23, 2007.)
The following information should be submitted on the claim:
- UPIN
- NPI (after 5/23/2007)
- Physician Last Name
- Physician First Name
- Physician Middle Initial
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