Rejection Message: Rejected for Invalid Information. Revenue Code for Services Rendered is Invalid

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Rejection Message

REJECTED FOR INVALID INFORMATION. REVENUE CODE FOR SERVICES RENDERED IS INVALID.

REVENUE CODE IS INVALID. CANNOT BE USED FOR OUTPATIENT CLAIMS.

REVENUE CODE IS INVALID. X12 INFO 2400-SV201

Definition

For this rejection message, a payer may not accept the combination of revenue code with bill type. Most commonly, if the bill type is inpatient, but the revenue code is outpatient, or vice versa, billers may see this rejection from the payer or from the intermediary.

Who defines what codes are or are not valid?

EDI standards, managed by www.cms.gov for healthcare guidelines, Uniform Code Council, ANSIX12 (American National Standards Institute for electronic transactions in America), NUBC (National Uniform Billing Committee) are a few of the entities that agree upon codes, terms, definitions, symbols, and formatting used to submit business documents electronically.

Examples:

Within the mental health and behavioral health industry, there are certain combinations of the bill type and revenue code that are acceptable; others are not. 

  1. An acceptable combination could be bill type 0132 with a revenue code of 0916 - Family Therapy. :
    • (leading zeros are ignored by CMS)
    • the '1' designating a hospital
    • the '3' designating outpatient
    • and the '2' designating an interim continuing claim

      This combination states the patient attended a family therapy session within an outpatient hospital setting - potentially at an on-site clinic or facility and is the first claim billed for the service. 

  2. An invalid combination could be bill type 0133 with a revenue code of 1002 for residential. 
    • (leading zeros are ignored by CMS)
    • the '1' designating a hospital
    • the '3' designating outpatient
    • and the '3' designating an interim continuing claim

      This combination states the patient is at an outpatient facility but receiving residential treatment. Most payers will reject this combination for the inconsistency between the outpatient bill type and the inpatient revenue code.

Resolution 

To help understand what bill types and revenue codes are available, search at www.cms.gov, or use links: Bill Types and Revenue Codes.  Once you understand how bill types and revenue codes work together, then you can resolve the rejection and resubmit the claim for payment.

Follow these steps:

1. Review the payer error message. 

The payer will give an explanation of the error between the bill type and revenue code.  Be aware that the exact rejection message may not exactly state that that bill type and revenue combination are invalid. 

  • For example, the payer error message states the revenue code is invalid when, in fact, the revenue code is valid.  What the payer is really stating is the revenue code is invalid when used with the bill type on the claim.

2. Determine what the bill type means.

We know from the previous information in this article that there are four digits to the bill type:

  • First Digit - Leading zeros are ignored by CMS)
  • Second Digit = Type of facility
  • Third Digit = Type of care
  • Fourth Digit = Sequence of this bill in this episode of care. Referred to as a "frequency" code

2. Determine what the revenue code represents.

  • Does the revenue code description match the bill code description?

3. Make the correction.

Once it's determined if the bill type or revenue code needs to be changed, then make the correction using the steps provided in the following articles:

  1. Bill type prefixes are changed using claim rules.
    1. Changing the bill type on a case-by-case basis: Claim Form Rule - Changing Bill Type Prefix
    2. Changing the bill type for all claims for that service: Box 4 - Type of Bill
  2. Revenue Codes are managed in the Service billing profile of a particular service. 

 

 

 

 

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