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Top Claim Submission Errors for Home Health Providers: Error 31018

Reason for error: Typically, home health claims are returned to provider (RTP) for correction with this reason code for one of two reasons:

  • There is a span of more than 60 days between the "FROM" and "TO" date submitted on the claim.
    • Example 1: "FROM" date billed is March 15 and the "TO" date billed is May 14, which equals 61 days
    • Example 2: "FROM" date billed is March 15, and the "TO" date billed is July 12, which equals 120 days
  • There is less than 60 days between the "FROM" and "TO" date submitted, and a patient status code "30" appears on the claim.
    • Example: "FROM" date billed is March 15 and the "TO" date billed is May 11, which equals 58 days. Patient status code "30" indicates the beneficiary remains a patient of the HHA at the end of the episode; therefore, the span between the "FROM" and "TO" dates cannot be less than 60 days.

Claim processing result: Return to Provider (RTP)

How to prevent/resolve:

  • Be aware that under the Home Health Prospective Payment System (HH PPS) the unit of payment is a 60-day episode of care
  • Verify the "FROM" and "TO" dates submitted on home health claims to ensure there is never a span of more than 60 calendar days submitted on a final claim (type of bill 329)
  • To determine the 60th day of an episode based on the "FROM" date, access the Home Health 60-Day Episode Calendar SchedulePDFquick resource tool.
  • If the span of days is less than 60 days, and the patient was discharged, enter the appropriate patient status code as of the "TO" date on the claim

Updated: 07.14.14

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