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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 37402


A hospice claim was submitted, but the previous claim is not found OR there is a gap between the “TO” date of the previous claim and the “FROM” date on the next claim.


Hospice claims must be submitted sequentially. This means that January's claim, for example, must be submitted before February's claim can be submitted.

Check the FISS Claim Inquiry Option (Option 12) to determine if the prior claim was submitted.

  • Example below: No prior claim in FISS


If prior claim was submitted, ensure it is in a "P", "D", or "R" status code before submitting the next claim.

  • Example below: Prior claim in "T" status; not "P", "D", or "R" as required.


Hospice claims must also be submitted consecutively. This means that there cannot be any skip in dates between the prior claim's "TO" date, and the next month's claim's "FROM" date; AND

Verify there is no gap between the "TO" date on the previous claim and the "FROM" date on the next claim.

  • Example below: Gap in dates between prior claim's "TO" date (0429YY) and next claim's "From" date (0501YY).


In addition, Hospices are required to bill claims monthly (see Medicare Claims Processing Manual (CMS Pub. 100-04), Ch. 11, §90). This means providers should bill only one claim per month, for each patient. The "To" date on the claim must be the last calendar day of the month, unless the patient died, was discharged or revoked hospice during the month.

In addition, hospice claims must conform to a calendar month (Jan 1 - Jan 31). Claims that span two months (ex. Jan 1-Feb 1) will be sent to the RTP file for you to correct.

Note: You must correct the claims out of Return to Provider (RTP) file sequentially. For example if the January claim is in RTP because of an invalid HCPC code, and the February claim was submitted, the February claim would go to RTP because no prior claim was found. You must first correct the January claim. Once the January claim is corrected and moves to a suspended status/location, the February claim can be F9ed out of RTP.

Additional resources:

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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