Top Claim Submission Errors (Reason Codes) and How to Resolve
Claim submission errors (CSEs) cause your billing transactions to either reject or move to your Return to Provider (RTP) file for correction, and create unnecessary costs to the Medicare program. Below is a list of the top errors listed by provider type. Click on the link to access the specific reason code, as well as resources you can use to avoid future billing errors. For instructions on how to correct claims in your RTP file, refer to the Fiscal Intermediary Standard System (FISS) Guide: Chapter Five: Claims Correction.
NOTE: As a Medicare provider, you are responsible to ensure the information submitted on your billing transaction is correct and compliant with Medicare regulations. Providers should be aware that action may be taken when they demonstrate a pattern of submitting claims inappropriately, incorrectly or erroneously, including a referral to the Office of Inspector General (OIG) for Medicare.
| Home Health/Hospice | Home Health | Hospice |
|---|---|---|
| 38200 | C7080 | U5106 |
| N5052 | C7010 | U5150 |
| 39071, 39072 and 39073 | U5233 and 7CS21 | U5181 |
| U538I | 31428 | |
| U538F | 31485 | |
| 31018 | 32030 | |
| 31102 | 37402 | |
| 31147 | 38031 | |
| 31755 | ||
| 32243 | ||
| 32907 | ||
| 38107 | ||
| 38157 |
Updated 03.13.13
