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Top Claim Submission Errors for Hospice Providers: 31485

Reason for error: Occurrence code (OC) 27 is required on all hospice notice of elections (NOEs) and initial claims following a hospice election. The date included with OC 27 should match the FROM date and the ADMIT date, except for hospice transfer claim. A hospice NOE/claim will receive this error when:

  • An NOE(8XA) is submitted without OC 27;
  • The OC 27 date on the NOE does not match the 'FROM' date and the 'ADMIT DATE';
  • An initial claim (8X1 or 8X2) following the hospice election or transfer (i.e. the 'FROM' date and 'ADMIT DATE' on the claim are the same) is submitted without OC 27; or
  • For an initial hospice election, the OC 27 date on the initial claim does not match the 'FROM' date and the 'ADMIT DATE'.
  • For a hospice transfer, the OC 27 date is either:
    • The START DATE of the current benefit period (as shown on ELGH/ELGA) that your claim falls within; or
    • The START DATE of the next benefit period (according to ELGH/ELGA) when your claim's dates of service overlap the TERM DATE of the current benefit period.

Claims processing result: Return to Provider (RTP)

How to prevent/resolve:

  • Ensure that your NOE (8XA) includes OC 27 with a date that matches the 'FROM' date and the 'ADMIT DATE'.

    Screenshot
  • Ensure that your initial claim (8X1 or 8X2) includes OC 27, and the date submitted with it matches the 'FROM' date and the 'ADMIT DATE'.

    Screenshot
  • For hospice transfers, ensure your initial claim (8X1 or 8X2) must include OC 27. The date submitted with the OC 27 is the START DATE of the current benefit period, OR the START DATE of the next benefit period.

    Example: ELGH shows the following:

    Screenshot

    If the dates of service on your initial claim are between March 18 and June 15, 20YY, the OC 27 date on your initial claim would be '031820YY'

    If the dates of service on your initial claim are after June 15, 20YY, the OC 27 date on your initial claim would be '061620YY'.

Updated: 12.14.18

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