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Reason Code Search and Resolution

Disclaimer: This is not a complete list of reason codes.

The Reason Code Search and Resolution tool allows you to view a reason code description and determine how to prevent/resolve the edit. You may search by reason code or keyword. All records matching your search criteria will be returned for your review. You may also select "Show all Reason Codes" to view the complete list.

If the reason code you enter does not display here, you may access any reason code description in the Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE) Reason Codes Inquiry Menu (Option 17) . For additional information, please reference the FISS DDE User Manual.

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Reason Code 31102


Home health providers receive errors for this reason code for one of two reasons:

  • The Request for Anticipated Payment (RAP) was submitted to Medicare containing Medicare Secondary Payer (MSP) information.
  • The final claim was submitted for conditional Medicare payment due to an open MSP record posted to the beneficiary's eligibility file; however, not all of the required claim information for this type of payment was submitted on the claim.


  • MSP information should not be submitted on RAPs, regardless of any MSP records impacting your dates of service. When billing your RAP to Medicare, ensure that you indicate Medicare as the primary payer.
  • Review the Medicare Secondary Payer (MSP) Billing & AdjustmentsPDF tool for all of the MSP claim information required for conditional payments using either Process C, D, F, H, I, or J.
  • When submitting your final claim to Medicare for a conditional payment, check the fields below to ensure the following data is entered:
    • Occurrence code 24 is entered in form locator (FL) 31-34. The OCC CDS/DATE fields are found on FISS Page 01. Enter occurrence code 24 in the first available field on this page.
      • Along with occurrence code 24, you must also submit one of the following when requesting a conditional Medicare payment in FL 31-34:
        • The date of denial by the primary insurance;
        • The date of last contact with the insurance/attorney; or
        • The date of the Explanation of Benefits (EOB)
    • Value code 12, 13, 14, 15, 16, 41, 43 or 47 and amount = 0000.00 is entered in FL 39-41. These fields are found on FISS Page 01.
      • IMPORTANT: Make sure the value code you are submitting corresponds with the type of MSP record posted to the beneficiary's eligibility file.
    • If your MSP claim can be submitted using FISS, a payer code of "C" should be entered on line A in the "CD" field on FISS Page 03.
    • Detailed remarks describing the reason for requesting conditional payment should be entered in FL 80. This field is found on FISS Page 04.
  • If the MSP record involves a conditional payment due to a med-pay/no fault (value code 14), liability (value code 47), or worker's compensation (value code 15) insurance, ensure that one of the following occurrence codes and the effective date of the MSP record (as posted on the beneficiary's eligibility file) is submitted on your final claim in FL 31-34 (OCC CDS/DATE fields on FISS Page 01):
    • 01, if med-pay
    • 02, if no-fault
    • 03, if liability
    • 04, if worker's compensation

If your claim is suspended (S status code) and reason code 31102 is assigned to your claim, no provider action is required. Please do not contact CGS about a home health claim suspended with reason code 31102 unless it has been in the same suspended status/location for more than 60 days.

Disclaimer: CGS' online tools and calculators are informational and educational tools only, designed to assist suppliers and providers in submitting claims correctly. CGS makes no guarantee that this resource will result in Medicare reimbursement for services provided. Although we've made every reasonable effort to provide effective resources, CGS is not responsible for the consequences of any decisions or actions taken in reliance upon or as a result of the information that these tools provide. CGS is not responsible for any human or mechanical errors or omissions.


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