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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 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 CorrectionExternal PDF.

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.

September 2017

Home Health Top RTP Reason Codes Short Narrative Monthly Total
38107 FISS can't match claim billed to processed RAP 8,423
U538I Overlapping episode of another HHA 1,531
31018 Episode "TO" date not 60 days greater than "FROM" date 781
U538F Overlapping episode; CWF discrepancy 541
31755 HIPSS date/date of service mismatch 528
34961 Present on Admission (POA) Indicator is not allowed 516
U5211 Dates of service overlap the date of death on file 380
Home Health Top Rejected Reason Codes Short Narrative Monthly Total
38157 Duplicate RAP 5,730
38200 Duplicate claim 2,328
37253 HH claim through date on/after 4/1/17 denied – no OASIS assessment found 853
Hospice Top RTP Reason Codes Short Narrative Monthly Total
37402 Hospice sequential billing error 1,928
34952 Service facility NPI not included 757
U5194 Hospice claim received for untimely NOE & occurrence span code 77 is missing or invalid 671
U5106 NOE falls within current hospice election 636
U5181 Occurrence code 27 required when certification date falls within dates of service 545
U5109 – See the November 26, 2014 MLN Connects Provider eNewsExternal PDF article, "Hospice Notices Returned to Provider" Submitted 8XB, 8XC or 8XD does not fall within a benefit period at CWF 517
31605 Revenue code shows as covered but date of service is within occurrence span code 74, 76, 77 or 79 426
Hospice Top Rejected Reason Codes Short Narrative Monthly Total
38200 Duplicate claim 883
39929 Claim rejected due to untimely submission of NOE 524
38031 Claim is exact duplicate to previously submitted claim 329

Previous Claim Submission Errors

Home Health/Hospice Home Health Hospice
1461A C7080 U5150
N5052 C7010 31428
39071, 39072 and 39073 U5233 and 7CS21 31485
  31102 32030
  31147 34923
  32243 34961
  32907 37541

Updated 10.13.17

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