Reason
Codes |
FISS Narrative |
Explanation and Suggestions |
| U5181 |
Hospice notice of election (NOE) or claim overlaps or begins on or after 08051997 and occurrence code 27 and date is not present; or if present is not equal to the first day of the new period. |
When the hospice notice of election or claim was submitted, it overlapped the certification dates for the beneficiary. The occurrence code 27 with the corresponding date was omitted. If the code was present on the claim it was not equal to the first day of the new period.
Ensure the usage of an appropriate certification or recertification date in accordance with occurrence code 27. Checking the certification dates in DDE is done on the CWF, pages 2 and 3 under the Hospice benefit periods. Note: Providers should also ensure that their software is programmed to correspond with these specifications. |
| U5150 |
Hospice claim received and no hospice master record present for this admission. Please submit a notice of election and then resubmit this claim. |
When the hospice claim was received for this beneficiary an NOE for this admission could not be located in the system.
Verify that the Notice of Election is submitted and processed before submitting claims.
Once you have determined that the NOE has successfully processed you will then need to go into 03 Corrections in DDE; pull up the claim in “T” status; go to any claim page and press the F9 key to resend the claim. This is often referred to as “releasing the claim”. |
| U5106 |
Hospice NOE received falls within a previously established hospice election period. |
When the hospice NOE was received it fell within a previously established election period. Verify that the Notice of Election (NOE) is billed with correct dates. If benefit period from the previous hospice is still open, allow that hospice to complete billing before updating the NOE.
Correct the NOE and submit with the correct dates. |
| 37402 |
The TOB is equal to hospice claim and the claim from date is greater than 04/01/98 and the claim receipt date is greater than or equal to 10/01/05. There is no claim pending or finalized with a thru date 1 day less than this claim’s from date. The reason code authorization field (claim page 9) does not contain this reason code. |
Claim has been received out of sequence. Previous claim has not completed processing or there is a gap in care dates.
Check dates on previous claim and/or make sure it was submitted. Hospice claims will not process when there is a gap in care dates. |
| 32116 |
The receipt date of the claim is on or after the NPI implementation date in the system control file and the billing provider NPI is not present on the claim.
*will not assign when the demo code is '31'. |
The receipt date of the claim is on or after the NPI The implementation date in the system control file and the billing provider NPI is not present on the claim. |
| U5157 |
Hospice claim received with a from date greater than the most recent hospice period and the prior was revoked. Please verify dates of service and determine if revocation was posted in error or if a new notice of election needs to be submitted. Make corrections and resubmit. Hardcopy submittors resubmit RTP report with corrections. |
When the hospice claim was received, there was no matching election period on file for this beneficiary. It is possible that the revocation was posted in error, or that a new NOE needs to be submitted.
Providers may access the CWF through DDE to verify election periods. A revocation indicator of ‘1’ will be present in CWF for the billing period prior to this claim submission. A revocation indicator of ‘1’ indicates the prior period has been closed with a discharge bill. This posted revocation/discharge date should be verified for accuracy before proceeding with correcting this current hospice claim. |
| T5052 |
CMS records indicate the beneficiary is not on file. Verify the beneficiary’s identification number and resubmit. |
This reason code is very similar to N5052. The beneficiary’s identification is incorrect or the Health Insurance Claim Number is not on the Master File. Therefore, the claim cannot process.
Verify the information on the beneficiary’s Medicare Card or check the HIQA for exact spelling of name and Jr/Sr information.
Make necessary corrections and F9 claim.
It may be necessary to contact the beneficiary for further verification. |
| U5166 |
Hospice claim from date falls within a posted hospice elections period and both the change of ownership date and the start 2 date are not present. The provider number on the claim does not match the provider number on the election period. If prior billing needs to be completed coordinate with prior hospice provider to complete billing and post a revocation if needed. |
The from date on the hospice claim falls within a posted hospice election period, and both the provider number date and the start 2 date are not present. The provider number on the claim does not match the provider number on the election period.
File NOE and claims promptly to prevent errors that occur when the second hospice agency has submitted claims prior to the first hospice agency completing billing. Contact the Provider Contact Center for guidance. Multiple situations may exist that will result in different resolutions, and the PCC is better equipped to determine the best resolution. |
| N5052 |
Beneficiary identification incorrect: the beneficiary name and or other personal data in the CWF transaction did not match the data stored on the beneficiary master record |
The beneficiary’s identification is incorrect or the Health Insurance Claim Number is not on the Master File.
Verify the information on the beneficiary’s Medicare Card or check the HIQA for exact spelling of name and Jr/Sr information.
Make necessary corrections and F9 claim.
It may be necessary to contact the beneficiary for further verification. |
| NT010 |
For intermediary use only; no provider action is required |
This code indicates a system issue. Providers should first refer to the Palmetto GBA “Claims Processing Issues” at www.PalmettoGBA.com/rhhi
In addition, providers may contact the Provider Contact Center (PCC) at: 866-801-5301 |