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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.

December 2019

Home Health Top CSEs Short Narrative Monthly Total
38107 FISS can't match claim billed to processed RAP 6,106
38157 Duplicate RAP 2,354
U538I Overlapping episode of another HHA 1,621
37253 No OASIS assessment found 886
31018 Episode "TO" date not 60 days greater than "FROM" date 872
U5065 The Medicare Beneficiary effective or end date is not within the dates of service submitted on the claim. 811
38200 Duplicate claim 721
U538F A RAP or final claim overlaps an existing episode 483
U5211 The dates of service (From and To Date) on the claim overlap the date of death on file for the patient at Common Working File (CWF). 436
37238 HCPCS G-codes for service visits are not reported with the correct revenue code for the service discipline 361
Hospice Top CSEs Short Narrative Monthly Total
37402 Hospice sequential billing error 1,891
U5181 Occurrence code 27 required when certification date falls within dates of service 859
U5106 NOE falls within current hospice election 747
34952 Service facility NPI not included 608
38200 Duplicate claim 547
U5194 Hospice claim received for untimely NOE & occurrence span code 77 is missing or invalid 495
39929 The hospice claim was rejected due to an untimely Notice of Election (NOE) 407
31605 A revenue code line with covered charges, however the service date on the revenue code line falls within the noncovered period indicated by occurrence span code 74, 76, 77 or 79.  293
31287 The patient status code equals 30 (still a patient) and the To date on the claim is not the last day of the month. 259
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. 237

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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 01.28.20

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