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.

October 2019

Home Health Top CSEs Short Narrative Monthly Total
38107 FISS can't match claim billed to processed RAP 6,575
38157 Duplicate RAP 2,550
U538I Overlapping episode of another HHA 1,595
38200 Duplicate claim 1026
37253 No OASIS assessment found 901
31018 Episode "TO" date not 60 days greater than "FROM" date 878
U538F A RAP or final claim overlaps an existing episode 422
U5200 Records indicate that the beneficiary is not entitled to Medicare Coverage for the type of service billed 389
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). 351
32243 The 0023 revenue code line is missing or charges not billed as required. 311
Hospice Top CSEs Short Narrative Monthly Total
37402 Hospice sequential billing error 1,886
U5200 Records indicate that the beneficiary is not entitled to Medicare Coverage for the type of service billed 1,149
U5181 Occurrence code 27 required when certification date falls within dates of service 806
U5106 NOE falls within current hospice election 752
34952 Service facility NPI not included 717
38200 Duplicate claim 543
U5194 Hospice claim received for untimely NOE & occurrence span code 77 is missing or invalid 489
37541 Condition Code D9 – no Remarks present 481
39929 The hospice claim was rejected due to an untimely Notice of Election (NOE) 400
37544 Provider submitted adjustment includes condition code D1 (change in charges), but all charges equal the charges on the original claim. 337

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Previous Claim Submission Errors

Home Health/Hospice Home Health Hospice
1461A C7080 31287
N5052 C7010 31428
34961 U5233 and 7CS21 31485
37541 30720  31605
39071, 39072 and 39073 31102 32030
  31147 34923
  31755 34961
  32243 38031
  32402 U5111
  32907 U5150
  37236 U5211
  37238 34923
  37253  31605

Updated 11.14.19

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