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Reason Code Search and Resolution

Disclaimer: This is not a complete list of reason codes.

The Reason Code Search and Resolution tool allows you to view a reason code description and determine how to prevent/resolve the edit. You may search by reason code or keyword. All records matching your search criteria will be returned for your review. You may also select "Show all Reason Codes" to view the complete list.

If the reason code you enter does not display here, you may access any reason code description in the Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE) Reason Codes Inquiry Menu (Option 17) . For additional information, please reference the FISS DDE User Manual.

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Reason Code 37236

Description:

Claims are denied with reason code 37236 when the NPI and/or physician's last name submitted on the home health claim does not match the physician's information at the Provider Enrollment, Chain, and Ownership System (PECOS).

Resolution:

  • Verify that the attending physician's NPI is present in the PECOS eligible physician file
  • Verify that the attending physician's name submitted on the claim matches the physician's name that is present in the PECOS file.
  • Verify that the special code is a valid code.

If the physician NPI or name was entered incorrectly on the claim, or if the physician NPI or name was initially incorrect in PECOS, and has now been corrected, you may submit a reopening request. Refer to the Ordering/Referring Denial Reopenings information on the CGS website for details.

Disclaimer: CGS' online tools and calculators are informational and educational tools only, designed to assist suppliers and providers in submitting claims correctly. CGS makes no guarantee that this resource will result in Medicare reimbursement for services provided. Although we've made every reasonable effort to provide effective resources, CGS is not responsible for the consequences of any decisions or actions taken in reliance upon or as a result of the information that these tools provide. CGS is not responsible for any human or mechanical errors or omissions.

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