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Top Claim Submission Errors for Home Health Providers: Error 38107

Reason for error: Home health final claim submitted; however, a processed, matching RAP cannot be found. The most common reasons for this error include:

  • A Request for Anticipated Payment (RAP) was required; however, a RAP was not billed, or a processed RAP was not found in FISS when the final claim was submitted.
  • The RAP auto-canceled because the final claim was not received timely. If the final claim is not received timely, FISS will automatically cancel the RAP and Medicare will recoup the RAP payment.
    • Under HH PPS, a final claim must match to a processed RAP within the greater of 60 days from the:
      • End of the episode; or
      • Date the RAP paid.
  • Key information on the final claim did not match the information submitted on the RAP. This includes:
    • Provider number/identifier of the billing home health agency (FL 56)
    • "FROM" date of the episode (FL 6)
    • Date of admission (FL 12)
    • First four positions of the Health Insurance Prospective Payment System (HIPPS) code (FL 44)
      • If the fifth position of the HIPPS code needs to change based on the provision of non-routine supplies, your HHA should ensure that the supply severity level between the RAP and final claim for the same episode of care does not change.
    • Date of service billed with the HIPPS code (FL 45)

Claim processing result: Return to Provider (RTP)

How to prevent/resolve:

  • Prior to submitting the final claim, access FISS Claim Inquiry option (Option 12) to determine if the RAP is in FISS status/location (S/LOC) P B9997
    • You should not submit the final claim for the episode unless the RAP is in this S/LOC
  • Review your Medicare Remittance Advice timely to verify the RAP has completed processing
  • Submit the final claim prior to the greater of 60 days from when the RAP paid or the end of the episode
  • Prior to submitting the final claim, ensure the RAP has not auto-canceled
    • Step 1: Access FISS Inquiry Option 12
    • Step 2: Enter your HHA's National Provider Identifier in the NPI field
    • Step 3: Enter the beneficiary's Medicare number in the MID field
    • Step 4: Enter P B9997 in the S/LOC field
    • Step 5: Enter 328 in the TOB field
    • Step 6: Enter your episode's start date in the FROM date field
    • Step 7: Press Enter
    • FISS will return a listing of billing transactions that meet the criteria entered
    • If a 328 type of bill is displayed, tab down to it and key an "S" in the SEL field
      • Press Enter
      • Press your F8 key to page forward to FISS Page 03
      • Review the information in the ADJUSTMENT REASON CODE field at the bottom of the screen
      • If the letters NF appear in this field, FISS auto-canceled your RAP because the final claim was not received timely
      • If your RAP auto-canceled, re-bill the RAP and wait for it to process (P B9997)
      • Submit the final claim for the episode
    • If FISS does not return a 328 TOB, press your F3 button and follow Steps 1 through 7
      • If FISS still does not return a 328 TOB, then your RAP did not auto-cancel
      • Submit the final claim for the episode
  • Prior to submitting the final claim, ensure that the key information (listed above) for the episode's RAP and claim matches.

Additional Resource

Posted: 10.31.18

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