Skip to main content
Corporate

Top Claim Submission Errors (Reason Codes) and How to Resolve

Claim submission errors (CSEs) cause your billing transactions to either reject or move to your Return to Provider (RTP) file for correction, and create unnecessary costs to the Medicare program. Below is a list of the monthly top RTP and reject errors listed by provider type. Click on the specific reason code to access resources you can use to avoid future billing errors. For instructions on how to correct claims in your RTP file, refer to the Fiscal Intermediary Standard System (FISS) Guide: Chapter Five: Claims CorrectionExternal PDF.

NOTE: As a Medicare provider, you are responsible to ensure the information submitted on your billing transaction is correct and compliant with Medicare regulations. Providers should be aware that action may be taken when they demonstrate a pattern of submitting claims inappropriately, incorrectly or erroneously, including a referral to the Office of Inspector General (OIG) for Medicare.

August 2020

Home Health Top CSEs Short Narrative Monthly Total
38157 Duplicate RAP 7,468
38107 FISS can't match claim billed to processed RAP 5,546
37253 No OASIS assessment found 2,912
31018 Episode "TO" date not 60 days greater than "FROM" date 1,178
U538I Overlapping episode of another HHA 934
38200 Duplicate Claim 762
U5391 No matching request for anticipated payment (RAP) 590
U538F RAP or final claim overlaps an existing period of care with the same provider number 535
34982 Occurrence code 50 is not present 392
32243 0023 revenue code line is missing or charges were not billed as required 378
Hospice Top CSEs Short Narrative Monthly Total
37402 Hospice sequential billing error 1,397
U5106 NOE falls within current hospice election 650
U5181 Occurrence code 27 required when certification date falls within dates of service 585
U5194 Hospice claim received for untimely NOE & occurrence span code 77 is missing or invalid 461
38200 Duplicate claim 451
34952 Service facility NPI not included 446
39929 The hospice claim was rejected due to an untimely Notice of Election (NOE) 387
30949 The adjustment (type of bill XX7, or XX8) or reopening request (type of bill XXQ) does not include a claim change reason code. 325
U5111 NOE received for revocation or void of election period and the start date on the transaction falls within a previously established hospice election period. 251
31605 The dates of services on the claim cannot be within the span code 77 dates unless the charges are non-covered 219

Reason Code Search and Resolution

For information about other reason codes, refer to the Reason Code Search and Resolution Web page. Note that this resource does not include a complete list of reason codes, just the most frequent.

Updated 09.14.20

Was this page helpful? YES NO


26 Century Blvd Ste ST610, Nashville, TN 37214-3685 © CGS Administrators, LLC. All Rights Reserved