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 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 FISS DDE User Manual.
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 |
---|---|
19963 | Statement 'From' Date less than 24 months from claim 'Admit' Date and a matching Home Health Notice of Admission (NOA) cannot be found |
31018 | Episode "To" date not 30 days greater than "From" date |
37253 | No OASIS assessment found |
37364 | No payment can be made since the corresponding NOA was received 30 days or more after the claim FROM Date. |
38055 | HH claim rejected. This claim had service dates that matched a claim already processed and at least one rev code was the same. |
38200 | Duplicate claim |
39929 | Each line of charges on this claim has been rejected and denied. |
U537F | A Home Health (HH) Notice of Admission (NOA) overlaps an existing HH admission. |
U537I | The From and Through dates on HH claim are outside the HH Admission period. |
U5233 | Services within HMO Period and No Hospice involvement or services not within Hospice Period. No Medicare Payment can be made. |
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 12.23.24