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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 CorrectionPDF.

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
1461A C7080 U5106
38200 C7010 U5150
N5052 U5233 and 7CS21 U5181
39071, 39072 and 39073 U538I 31428
U5211 U538F 31485
  31018 32030
  31102 34923
  31147 34952
  31755 37402
  31790 38031
  32243  
  32907  
  38107  
  38157  

Updated 10.15.15


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