Claims Processing Issues Log

Here is a list of current system-related claims payment and processing issues. These issues have been reported to the Centers for Medicare & Medicaid Services (CMS) and/or the Fiscal Intermediary Standard System (FISS). Please check often for updates before contacting the provider contact center. The issues are identified by stand alone articles and will be updated as needed.

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Latest Articles


RESOLVED: Home Health: Penalty for Requests for Anticipated Payments (RAPs) Received More Than Five Days Early 03/03/2021
RESOLVED: No Payment Amount on Low Utilization Payment Adjustment (LUPA) Claims with Late Requests for Anticipated Payment (RAP) Penalties 03/03/2021
Home Health: Penalties for Late Requests for Anticipated Payments (RAPs) Not Being Deducted from Final Reimbursement 03/02/2021
Home Health: Claims Spanning 2020-2021 Not Applying Correct 2021 Payment Rate 02/23/2021
RESOLVED: Home Health: Reason Code 38107: Fields on the Requests for Anticipated Payments (RAPs) and Final Claim Information Do Not Match 02/17/2021
RESOLVED: Home Health: Reason Code U5391, Fields on the Requests for Anticipated Payments (RAPs) and Final Claim Information Do Not Match 02/17/2021
Hospice Reason Code U5106: Notices of Elections (NOEs) Posting Elections to the Common Working File, But Returning to Provider 02/09/2021
Recoding of Health Insurance Prospective Payment System (HIPPS) Codes from Late to Earlier Periods on Home Health Claims When There Is Separation Between the Periods of Less than 60 Days 02/02/2021
RESOLVED: Home Health Accountable Care Organization (ACO) Reductions Not Recouping Request for Anticipated Payment (RAP) Reimbursement with Reason Code 3719Q 02/02/2021
Home Health: Reason Code 37363 01/28/2021
Home Health Reason Code W7216 - Requests for Anticipated Payments (RAPs) Returned to Provider (RTP) Incorrectly for an Invalid Line Item Date 01/27/2021
RESOLVED: Home Health Reason Code 37253 - Claims Returned to Provider (RTP) Due to OASIS Assessment Not Found 01/26/2021
Hospice Payment Rates for Routine Home Care (RHC) on and after January 1, 2016 10/28/2020
Home Health Reason Codes U524P/U524Q - Some Home Health Final Claims are Cycling in the System for the Timing of the Period/Episode 10/12/2020
RESOLVED: Home Health HIPPS Recoding Error Affecting Claims that Span January 1, 2020 10/12/2020
RESOLVED: Home Health Reason Code C727E - Home Health PDGM Claims are Suspending Incorrectly with Reason Code C727E 10/12/2020
RESOLVED: Claims Returning for Reason Code C5467 for the Review Choice Demonstration (RCD) 07/06/2020
Hospice Claims Editing for Reason Code U5181 03/26/2020
Hospice Notice of Transfer (NOTR), Type of Bill (8XC) 03/26/2020
Hospice Period Dates Not Calculating Correctly on the Common Working File (CWF) 09/26/2019

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