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March 19, 2015

Possible Issue Related to Ordering/Referring Physician Reason Codes 37236 and 37237

CGS is aware of a possible issue that is causing an increase in calls to the Home Health & Hospice Provider Contact Center. It appears that some home health claims and adjustments may have been denied inappropriately with reason code 37236 or 37237. This issue has been reported to the FISS system maintainers to research.

Some home health claims and adjustments are being submitted with ordering/referring physician information that matches the Medicare Ordering and Referring File on the Centers for Medicare & Medicaid Services (CMS) website. However, the provider file in the Fiscal Intermediary Standard System (FISS) indicates that the physician's information is not on the Provider Enrollment, Chain and Ownership System (PECOS) file.

CGS will provide additional information as soon as it becomes available.

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