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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 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
1. U537F A Home Health (HH) Notice of Admission (NOA) overlaps an existing HH admission.
2. U5233 Dates of service billed are within a beneficiary Medicare Advantage (MA) plan enrollment period; therefore, no Medicare payment can be made.
3. 37253 This reason code is assigned when there is no corresponding OASIS assessment found in Medicare's systems related to the claim.
4. 19963 Statement "From" Date is on or after 01/01/2022 and less than 24 months from claim "Admit" Date and a matching Home Health Notice of Admission (NOA) cannot be found.
5. 31018 Episode "To" date not 30 days greater than "From" date
6. 37364 The dates of service fall within the span of days between the NOA receipt date and the claim From date on TOB 32X with Statement From Date on or after 01/01/2022, the NOA receipt date is 30 or more days from the claim From date, the payment amount returned from HH Pricer is equal to zero and the PROVIDER REIM field on MAP103A is blank.
7. 38200 The Fiscal Intermediary Standard System (FISS) has found a previously submitted billing transaction for the same beneficiary and dates of service with the same provider number; therefore, the second billing transaction submitted by the provider is a duplicate.
8. U537I The From and Through dates on HH claim are outside the HH Admission period.
9. 38055 This home health claim was submitted as a Medicare primary claim and contains exact service dates corresponding to a previously submitted claim for the same provider with at least one matching revenue code.
10. 37238 The HCPCS G-code submitted is not reported with the correct corresponding revenue code.
  Hospice Top CSEs Short Narrative
1. 37402 A hospice claim was submitted, but the previous claim is not found OR there is a gap between the "TO" date of the previous claim and the "FROM" date on the next claim.
2. U5106 Hospice elections and benefit periods are posted to the Common Working File (CWF) when notice of elections (NOEs) and/or claims are processed. When another hospice NOE is submitted that overlaps the election/benefit period posted to CWF, including a duplicate NOE, the NOE will receive reason code U5106.
3. 38200 The Fiscal Intermediary Standard System (FISS) has found a previously submitted billing transaction for the same beneficiary and dates of service with the same provider number; therefore, the second billing transaction submitted by the provider is a duplicate.
4. U5194 The occurrence span code (OSC) 77 is missing or the dates are incorrect.
5. U5181 Hospices use occurrence code (OC) 27 and the date on all notices of election (NOEs) and initial claims following a hospice election. OC 27 and the date are also required on all subsequent claims when the claim's dates of service overlap the first day of the next benefit period. When OC 27 is required, but not reported, or does not include the correct date, the NOE or claim will receive this reason code.
6. 34952 Service facility NPI not included
7. 39929 This claim was rejected due to an untimely Notices of Election (NOEs) or for Home Health claims with all line charges rejected.
8. 31605 The dates of services on the claim cannot be within the span code 77 dates unless the charges are non-covered.
9. U5065 The Medicare Beneficiary Identifier (MBI) effective or end date is not within the dates of service submitted on the claim.
10. 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.

For information about other reason codes, refer to the Reason Code Search and Resolution tool. Note that this resource does not include a complete list of reaosn codes, just the most frequent.

Updated: 10.24.2025

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