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 monthly top RTP and reject errors listed by provider type. Click on the specific reason code to access 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 Top CSEs | Short Narrative |
---|---|
38157 | Duplicate RAP |
38107 | FISS can't match claim billed to processed RAP |
37253 | No OASIS assessment found |
U538I | Overlapping episode of another HHA |
38200 | Duplicate Claim |
U5391 | No matching request for anticipated payment (RAP) |
31018 | Episode "TO" date not 60 days greater than "FROM" date |
U5387 | The patient status code is "30" and the through date does not equal the episode end date on file. |
U538F | RAP or final claim overlaps an existing period of care with the same provider number |
C7010 | No condition code 07 to indicate services unrelated to hospice election |
Hospice Top CSEs | Short Narrative |
37402 | Hospice sequential billing error |
38200 | Duplicate claim |
U5106 | NOE falls within current hospice election |
U5181 | Occurrence code 27 required when certification date falls within dates of service |
34952 | Service facility NPI not included |
U523A | The dates of service on this claim are during both a Hospice election period and Medicare Advantage Plan Period that is Value-Based Insurance Design (VBID) Model. No resolution is required by providers. Refer to the U523A Reason Code Search and Resolution information for details. |
39929 | The hospice claim was rejected due to an untimely Notice of Election (NOE) |
U5194 | Hospice claim received for untimely NOE & occurrence span code 77 is missing or invalid |
31605 | The dates of services on the claim cannot be within the span code 77 dates unless the charges are non-covered |
31503 | The total units on the level of care lines (0651, 0652, 0655, 0656) do not equal the number of days in the billing period. |
Reason Code Search and Resolution
For information about other reason codes, refer to the Reason Code Search and Resolution Web page. Note that this resource does not include a complete list of reason codes, just the most frequent.
Updated 11.24.21