Skip to Main Content

Print | Bookmark | Email | Font Size: + |

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.

Home Health Top CSEs Short Narrative
38157 Duplicate RAP
38107 FISS can't match claim billed to processed RAP
37253 No OASIS assessment found
U538I Overlapping episode of another HHA
38200 Duplicate Claim
U5391 No matching request for anticipated payment (RAP)
31018 Episode "TO" date not 60 days greater than "FROM" date
U5387 The patient status code is "30" and the through date does not equal the episode end date on file.
U538F RAP or final claim overlaps an existing period of care with the same provider number
C7010 No condition code 07 to indicate services unrelated to hospice election
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 11.24.21


26 Century Blvd Ste ST610, Nashville, TN 37214-3685 © CGS Administrators, LLC. All Rights Reserved