How do I review claims that have been returned to provider?
When a claim has incomplete, incorrect or missing information, it will be sent to your return to provider (RTP) file to correct. To review your claims in the RTP file:
- Access the Claims Correction Menu (Option 3) via the Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE).
- Select the appropriate Claims Correction option appropriate for your type of bill to access the Claim Summary Inquiry screen.
- On the Claim Summary Inquiry Screen, enter your National Provider Identifier (NPI) in the NPI field.
- You may need to change the TOB field if the default type of bill doesn't apply.
- Press Enter
The claims in the RTP file will display for the NPI number entered. Access each claim and review the reason code narrative that explains why the claims went to the RTP file.
Access the following resources for additional information and guidance.
- DDE User Manual/FISS Reference Guide, Chapter 5: Claims Correction.
- Top Claim Submission Errors Web page
- Reason Code Search and Resolution Self-Service Option