Medicare_Claims_Processing_Manual / Chapter_1 / 80.3.1

Why This Topic Matters

Understanding these terms helps billers and claims staff recognize how Medicare distinguishes incomplete or invalid claims from denied claims and how claims may be routed for correction or resubmission.

Article Sections

1. Incomplete or Invalid Claims Processing Terminology

   Introduces the scope of the terminology used for claims that cannot be processed as submitted. It frames the section within Medicare claims-processing guidance.

2. Definitions and claim status concepts

   Defines the major claim-status terms and related information categories used in this section. The discussion focuses on general processing language and data elements relevant to claims handling.

3. Return as Unprocessable or Return to Provider (RTP)

   Describes the general RTP concept and several high-level ways claims may be identified and routed for correction. It also addresses the handling outcomes associated with unprocessable claims.