(A claim in “T” status means that Medicare has returned the claim to the provider for correction.)

 Reference Article:  My Medicare EOE Denied For Reason Code 38107

If your claim has been put in “T” status, due to denial code 38107:

Verify the following:

A.  Is there a processed RAP in the DDE System?  If there is no RAP, do the following:

1.         Submit RAP to Medicare

2.         Once Medicare makes RAP payment, log into DDE system (Medicare system)

3.         Access the FSS0 screen

4.         Choose option 03, then option 27

5.         Put in HIC # to access the EOE claim

6.         At the claim, type in the letter U

7.         Press Enter

8.         On any screen page, press the F9 tab to update/send your EOE claim for processing

When your EOE claim is put in “T” status, because there is no RAP on file, the only correction that needs to be made is Medicare receiving the RAP claim.  That correction is fulfilled when you submit the RAP for payment and Medicare process the RAP.  When you go into DDE, and pull up that claim, all you have to do is hit F9 to update the EOE laim, for payment consideration.

B.  If there is a processed RAP in DDE, verify the following:

·         Has the RAP been autocancelled?   In CWF, the episode will show a patient indicator 1. If the RAP was cancelled, resubmit the RAP and follow steps above.

 

·         If there is a processed RAP, ensure that the RAP and EOE claim information matches in these fields: Statement FROM date , Admission date, HIPPS code, 0023 revenue code line, and Item service date (Field 45).  If there are any differences, proceed with the following:

a.     If the EOE claim information is correct, cancel the processed RAP. Once this processes, resubmit a new RAP with information that matches the EOE claim.  Once the RAP repays, pull up the EOE claim in DDE.  Follow steps 3-8, listed above.

b.    If the RAP information is correct, make the necessary changes on the EOE claim in ‘T’ status.  Follow steps 3-7, make the changes to the EOE, and F9 the claim in DDE.

When the EOE claim has been correctly updated, you will be taken back to the initial screen.