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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.

April 2020

Home Health Top CSEs Short Narrative Monthly Total
37253 No OASIS assessment found 12,153
38107 FISS can't match claim billed to processed RAP 9,960
38157 Duplicate RAP 7,904
38200 Duplicate claim 1,832
31018 Episode "TO" date not 60 days greater than "FROM" date 1,526
U538I Overlapping episode of another HHA 1,201
32243 0023 revenue code line is missing or charges were not billed as required 1,174
37236 NPI and/or physician's last name submitted on the home health claim does not match the physician's information at the Provider Enrollment, Chain, and Ownership System (PECOS) 961
31755 The date on the 0023 revenue code line does not match the admit date and from date on the start of care episode, or the final claim does not contain a visit equal to the service date on the 0023 revenue code line. 775
U5391 No matching request for anticipated payment (RAP). 702
Hospice Top CSEs Short Narrative Monthly Total
37402 Hospice sequential billing error 2,111
38200 Duplicate claim 1,790
U5181 Occurrence code 27 required when certification date falls within dates of service 822
U5106 NOE falls within current hospice election 745
34952 Service facility NPI not included 661
U5194 Hospice claim received for untimely NOE & occurrence span code 77 is missing or invalid 468
31428 Appropriate HCPCS not present with discipline revenue code. 385
39929 The hospice claim was rejected due to an untimely Notice of Election (NOE) 354
30995 Claim with dates of service on or after January 1, 2020, must be submitted with the Medicare Beneficiary Identifier (MBI). 323
U5150 A hospice claim was received; however, no Notice of Election (NOE) is on file. 303

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 05.19.20

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