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October 7, 2021

Reminder: HIPPS Codes on RAPs and Final Claims

Due to the number of Provider Contact Center (PCC) inquiries related to non-matching Health Insurance Prospective Payment System (HIPPS) codes on Requests for Anticipated Payment (RAPs) and final claims, please reference the following Frequently Asked Question (FAQ):

For RAPs with a "From" date on or after January 1, 2021, are Health Insurance Prospective Payment System (HIPPS) codes still required on RAPs? If yes, do the HIPPS need to match on the RAP and final claim?

Yes, HIPPS codes are still required on RAPs and an HHA may submit any valid HIPPS code. As stated in the CMS Pub. 100-04, Ch. 10, section 40.1, "For RAPs with "From" dates on or after January 1, 2020, the HHA may submit the HIPPS code they expect will be used for payment if they choose to run grouping software at their site for internal accounting purposes. If not, they may submit any valid HIPPS code in order to meet this requirement."

For the final claim, the 0023-revenue code line must be reported with the HIPPS code that was reported on the RAP. The first four positions of the code must be identical to the value reported on the RAP. This allows the system to match the claim with the corresponding RAP. As a reminder, the fifth position of the HIPPS serves as a placeholder. Reference: CMS Pub. 100-04, Ch. 10, section 40.2External PDF

Additional FAQs related to RAP submission and other topics are available on the J15 HHH FAQs page.

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