Frequently Asked Questions Return to Provider (RTP) / Reject Reason Codes

Where can I find more information about fixing my home health claims in RTP with reason codes 31018 and 32907?

Cahaba has developed Web help pages to assist home health providers in resolving reason codes 31018 and 32907. Please access the Web page, Top Claim Submission Errors for Home Health Providers: Error 31018 and Top Claim Submission Errors for Home Health Providers: Error 32907.

(July - Sept. 2008 FAQ – reviewed Nov. 2008)

Can you provide more information why hospice claims need correction for reason codes U5106 and 31485?

Yes, refer to the Web pages, Top Claim Submission Errors for Hospice Providers: Error U5106 and Top Claim Submission Errors for Hospice Providers: Error 31485 for more information about why hospice claims receive these errors and how providers can avoid receiving them in the future.

(July - Sept. 2008 FAQ – reviewed Nov. 2008)

We are a hospice agency with claims going to RTP with reason code 32030? Why are we receiving this error?

For dates of service beginning January 1, 2008 and after, Change Request 5670 was implemented, which requires the reporting of a new value code, G8, when revenue codes 0655 and 0656 are billed by hospices. For more information regarding this reason code, please access the Web page, Top Claim Submission Errors for Hospice Providers: Error 32030.

(Jan. – March 2008 FAQ – reviewed Nov. 2008)

Our Medicare claims rejected as untimely. Do we have any recourse regarding this?

Information regarding timely filing requirements for Medicare claims can be found in the Medicare Claims Processing Manual (Pub. 100-04, Ch. 1, §70). Please review the information published in section 70.7 of this resource to determine the situations when exemptions may be granted to timely filing constraints.

(Jan. – March 2008 FAQ – reviewed Nov. 2008 )

We are receiving reason code 31755 with our home health RAPs and claims. How can we prevent this from occurring?

Please see the Web page, Top Claim Submission Errors for Home Health Providers: Error 31755 for assistance in preventing this billing error.

(Oct. – Dec. 2007 FAQ – reviewed Nov. 2008)

Do you publish information about claim submission errors (CSEs) and how to resolve them? If so, where can I find it?

The Cahaba Web page, Top Claim Submission Errors and How to Resolve is available for providers to review the top CSEs experienced by home health and hospice providers. Each reason code contains the reason for the error and provides an explanation and/or links to resources to assist in resolving/preventing the error in the future.

(July – Sept. 2007 FAQ – reviewed Nov. 2008)

Do you publish information on the status of claims processing issues with the Fiscal Intermediary Standard System (FISS)?

The Web page, Fiscal Intermediary Standard System Claims Processing Issues is available for providers to check the status of known or reported claims processing issues. Please refer to this Web page before calling the Provider Contact Center with questions.

(April - June 2007 FAQ – updated Nov. 2008)

I received reason code 32226 for my home health claim in RTP. How can I resolve this?

Home health claims receive reason code 32226 when the revenue code billed requires units and not all revenue codes have units, as required. For more information, please access the Web page, Top Claim Submission Errors for Home Health Providers: Error 32226, for assistance in resolving/preventing this billing error.

(Jan. – March 2007 FAQ – reviewed Nov. 2008)

What causes home health claims to need correction for reason code 38107? How can this reason code be prevented?

Home health claims are frequently returned to providers for correction with reason code 38107 because:

A Request for Anticipated Payment (RAP) was required; however, a RAP was not billed, or a processed RAP was not found in the Fiscal Intermediary Standard System (FISS) when the final claim was submitted. RAPs are required when 5 or more visits are provided to the beneficiary during a home health episode of care.
Key information on the final claim did not match the information submitted on the RAP.
The RAP auto-canceled because the final claim was not received timely. If the final claim is not received timely, FISS will automatically cancel the RAP and Medicare will recoup the RAP payment. Under the Home Health Prospective Payment System (HH PPS), a final claim must match to a processed RAP within the greater of 60 days from the:

End of the episode or
Date the RAP paid.

Tips for preventing or avoiding this reason code are available on the Top Claim Submission Errors for Home Health Provicers: Error 38107 Web page. Please access this resource for more information.

(Jan.-March 2007 FAQ – reviewed Nov. 2008)

I know that hospices are required to bill sequentially. If I don't, I can get two different reason codes; U5150 and 37402. What's the difference between these reason codes?

Hospice providers received reason code U5150 when a hospice claim was submitted, but a processed NOE is not found, either because it was not submitted or it was not processed (P B9997) before the claim was submitted. Reason code 37402 is applied when a hospice claim was submitted, but the previous claim is not found OR there is a gap between the “To” date on the previous claim, and the “From” date on the next claim. Please access the Web pages, Top Claim Submission Errors for Hospice Providers: Error U5150 and Top Claim Submission Errors for Hospice Providers: Error 37402 for more information on these reason codes and how to avoid claim submission errors received for them.

(July - Sept. 2006 FAQ – reviewed Nov. 2008)

I am trying to bill hospice services for a beneficiary, and am getting reason code U5211 saying the services are after the date of death, but the date of death is not correct. How does the incorrect date of death get posted? How does this get corrected?

When a hospice claim is submitted with a patient status code indicating death, the claim’s “Through” date is reported to the Common Working File (CWF) as the date of death. Once a date of death is posted to CWF, any claims submitted with dates of service on or after that date of death will not pay.

In addition, an incorrect date of death that has posted to CWF can only be corrected through the Social Security Administration, and can take several months to correct. Hospice providers should not submit Medicare claims until an incorrect date of death is corrected, as claims submitted to Medicare with dates of service after the incorrect date will reject with reason code U5211, preventing providers from receiving payment.

To prevent your claims from being inappropriately rejected, and incorrect dates of death posted to CWF, ensure the patient status code indicating death (40, 42 or 43) is only submitted on the patient ’s final claim (type of bill 8X1 or 8X4), and the “Through” date on the claim is the patient’s actual date of death.

(July - Sept. 2006 FAQ – reviewed Nov. 2008)

Why did my claim reject?

Claims can reject for a number of reasons. The most common reasons why claims reject are for eligibility errors, or duplicate claim submissions. Rejected claims can be identified with a status code of “R”. The reason code narrative assigned to a rejected claim will inform you as to the reason why your claim rejected.

(Oct.-Dec. 2005 FAQ – reviewed Nov. 2008)

My claim rejected with reason code 38200. How do I keep this from occurring?

Reason code 38200 occurs when a provider submits multiple claims to Medicare for the same beneficiary with the same date of service. This reason code narrative states, "This claim is an exact duplicate of a previously submitted claim." You can avoid having claims reject due to the duplicate submission of billing transactions by following the tips found on the Top Claim Submission Errors for All Providers: Errors 38200 and 38157 Web page.

(Oct.-Dec. 2005 FAQ – reviewed Nov. 2008)

Why does my claim need correction?

Claims are returned to you for correction because the information contained on them is incomplete, incorrect or missing. These claims reside in the claims correction file, which is also known as the Return to Provider (RTP) file. Claims in your RTP file are found in FISS status/location T B9997. By viewing the reason code narrative in FISS, you can determine the reason why your claim needs correction. For more information about viewing reason codes and correcting claims, please review the information found in the Claims Correction section of the FISS Reference Guide. In addition, Cahaba also publishes a listing of the top reasons why claims need correction.

(Oct.-Dec. 2005 FAQ – updated Nov. 2008)

I can't figure out how to fix my claim. The reason code doesn't make any sense.

Some reason code narratives are easy to interpret. Others are more difficult to decipher to know what exactly needs correction. The following tips may help when working with the more difficult reason codes:

If you are unsure what errors need correction after reading the reason code narrative, pick a few key words mentioned and then check the field locators or appropriate screens that correspond to verify the data listed is valid and doesn't conflict with what you billed.
Make a cheat sheet of the reason codes that are unclear or that a Cahaba customer service representative has assisted you with, and record notes in your own words that will help you resolve the same type of billing issue in the future.
If one reason code continually causes problems for you, mention the code to a customer service representative the next time you call Cahaba and obtain further clarification on the narrative and what causes this reason code to occur.

(Oct.-Dec.2005 FAQ – reviewed Nov. 2008)

How can I correct my claims using FISS?

To correct claims using FISS, providers will need to sign on to FISS and select the 03 (Claims Correction) option from the FISS Main Menu. From the Claim and Attachments Correction Menu screen, enter the option that matches your provider type (27 for home health agencies and 29 for hospices) and press “Enter”. Once the Claim Summary Inquiry screen appears, providers can access their RTP file by entering their National Provider Identifier (NPI) and pressing <Enter>. Please note: the type of bill (TOB) defaults to a type of bill for your provider type. You may need to change this, depending on whether you submit different types of bills for your provider type. For example, home health agencies may need to check for 32, 33 or 34 types of bills.

Step-by-step instructions are available to assist providers in correcting their claims using the FISS system. The can be found in the Claims Correction section of the FISS Reference Guide.

(Oct.-Dec. 2005 FAQ – updated Nov. 2008)

Page last updated: December 4, 2008