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March 25, 2020

Reason Code 37253: What to Look For

For home health claims with From dates on or after January 1, 2020, matching your claim with the Outcome and Assessment Information Set (OASIS) is more important than ever. Based on the claim submission error data, the reason code 37253 (no OASIS found) is one of the top errors for home health providers. To help prevent your claims from going to the Return to Provider (RTP) file with 37253, we have provided an example of the Internet Quality Improvement and Evaluation System (iQIES) validation report showing what must match between the claim and the OASIS.

OASIS Final Validation Report (FVR) Example:
Screenshot

Step 1 – Before submitting your claim, review the OASIS FVR Report to ensure the OASIS assessment was successfully accepted.

Step 2 – Check the FVR to confirm the receipt date shows the OASIS was accepted by iQIES before you submitted your claim. This date is shown on Page 1 of the report, in the "Completion Date/Time" field. Also ensure that the assessment has not been inactivated.

  • If the OASIS was submitted after the claim, resubmit the claim. If the claim is in the RTP file (T B9997), press F9.
  • If the assessment was inactivated, resubmit the assessment.

Step 3 – Check the Reason for Assessment (RFA) (OASIS Item M0100). It must be equal to 01, 03, 04, or 05.

  • If the claim matches an assessment that is for another reason, update the occurrence code 50 date on the claim to correspond to the M0090 date of the applicable assessment and resubmit the claim.

Step 4 – Check the occurrence code 50 and ensure that you are reporting the assessment completion date (Item M0090).

Step 5 – Check the claim you submitted with the OASIS to ensure the following items match.

  • CMS Certification Number (OASIS Item M0010) – This is your agency's Medicare provider number, (often referred to as PTAN).
  • Medicare Beneficiary Identifier (MBI) (OASIS Item M0063) – Effective January 1, 2020, regardless of the dates of service, all claims must be submitted with the new MBI. If the OASIS was submitted with the Health Insurance Claim Number (HICN), the OASIS will need to be corrected.
    • Changes to a beneficiary's MBI may occur. Verify the MBI using the MBI look-up tool via myCGS. Refer to the myCGS MBI Look-up Tool for details on how to verify the MBI. If the MBI has changed, update Item M0063 on the OASIS and resubmit the claim.
  • Assessment Completion Date (OASIS Item M0090) – This is the date submitted on the claim with occurrence code 50.

If the claim and OASIS have correct and matching information, contact the Provider Contact Center (PCC) at 1.877.299.4500 (Option 1).

References:

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