Corporate

September 12, 2019 - Revised: 09.18.19

Reason Code 37253: No Corresponding OASIS Assessment Found

The home health and hospice Provider Contact Center (PCC) have received an increase in calls related to reason code 37253. This reason code causes your claim to go to the Return to Provider (RTP) file when there is no corresponding OASIS assessment found related to the claim. Since 37253 has also recently appeared in the top claim submission error (CSE) listing, please review the following information.

How to Prevent 37253

  • Before submitting your claim and the OASIS assessment, ensure the following OASIS items are correct. These items are used to match the claim with the OASIS assessment.
  • Home health agency (HHA) Certification Number (OASIS item M0010)
  • Beneficiary Medicare Number (OASIS item M0063)

    Note: CGS encourages providers to begin submitting the OASIS assessment and claims with the beneficiary's Medicare Beneficiary Identifier (MBI). All claims submitted with the Health Insurance Claim Number (HICN) on or after January 1, 2020 will be denied.

  • Assessment Completion Date (OASIS item M0090)
  • Reason for Assessment (OASIS Item M0100) equal to 01, 03, or 04

It is also important that you ensure the OASIS assessment has completed processing and was successfully accepted into the Quality Information and Evaluation System (QIES) National Database. Verify this by reviewing the OASIS Agency Final Validation Report or OASIS Submitter Final Validation Report for the submission which included the assessment. These reports will provide information that confirms the assessment's receipt, the date of receipt, and any fatal or warning errors encountered.

If Your Claim Is in RTP (T B9997)

  • Review the OASIS and claim and correct any errors to ensure they match and then resubmit (F9) the claim out of the RTP file.
    • It is important that you verify that the OASIS was successfully accepted into the QIES database. The PCC staff does not have access to this information. If the OASIS was successfully accepted and verified in QIES and the required data elements match the claim, but you continue to encounter issues, please contact the PCC at 1.877.299.4500 (option 1) for further assistance.
    • If there is no error and it is determined the services did not meet the condition of payment, submit a claim for denial using the following coding elements:
      • Type of bill 0320, which indicates the expectation of a full denial
      • Occurrence Span Code 77 with span dates matching the From/Through dates of the claim to indicate acknowledgement of liability for the billing period.
      • Condition Code D2 indicating the change in billing the HIPPS code to non-covered.
      • Condition Code 20.
      • DO NOT use condition code 21.

For additional information, refer to the following resources.

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