month/year after an initial 56900 denial.
1. The title of the report is as follows:
Listing of Part A Hospice Claims with Medical Review Denials by Provider On Adjusted Claims Reviewed after an Initial 56900 Denial on Part A Hospice Claims Processed By Palmetto GBA in Month/Year. A sample of this report is attached for reference. This report includes the following:
- Provider ID - Provider's Medicare Identification number
- Provider Name ' Name of the provider
- Total Claims Reviewed - Total number of claims reviewed for the specific provider in the specified month/year
- Total Claims Denied ' Total number of claims denied for the specific provider in the specified month/year
- Rank of Denial Code Group for Provider - The provider-specific ranking of their denial reason(s) based on the frequency that they occur
- Denial Code Group ' The denial code(s) that indicate the reason(s) for which each claim denied
- HICN ' Health Insurance Claim Number issued to Medicare patients to identify entitlement to Medicare benefits
- Patient Name ' The name of the patient for which the claim was billed
- DCN - (Document Control Number) ' A unique identification number assigned to each claim when it is received by Palmetto GBA for processing
- Bill Type ' 81X Hospice type of bill
- From Date ' The beginning date of service for the claim
- Process Date ' The date the claim is finalized by the processing system
Letter Three: Two or more denied claims processed during a specified month/year, and one or more denied claims processed in a specified month/year after an initial 56900 denial. This TIP Letter includes the following information for each provider with two or more denied claims processed during a specified month/year and one or more denied claims processed in a specified month/year after an initial 56900 denial:
- The provider name and number
- SUBJECT- Medicare Hospice Services Non-covered (Denied) on Claims Processed in Month/Year, Including Denials Received after an Initial 56900 Denial.
- The reason the letter is being sent
- The combined information as indicated in Letter One and Letter Two
These letters include a reminder that Part A Hospice TIP Letters are to be used for educational purposes only. A TIP Letter is not a denial notification for appeals purposes. Please refer to the Remittance Advice (RA) for denial notification.