RESOLVED: Hospice and Home Health Claims Editing for Reason Code 5ZXXX, Changing the Type of Bill to Non-Pay

Published 02/28/2024

RESOLVED: Hospice and Home Health Claims Editing for Reason Code 5ZXXX, Changing the Type of Bill to Non-Pay
Current Status Date  
Resolved March 18, 2024 Status: Palmetto GBA has completed adjusting the “5Z” Reason Code incorrectly denied claims. For hospices, the adjustment types of bills are 81I or 82I and for HHAs it is 32I. These bill types show on Remittance Advices on the date they processed. 

Provider Action: If an HHH provider had a claim deny for another “5Z” Reason Code other than the six codes listed above or the claim was processed (shown on a Remittance Advice) prior to February 7, 2024, those were correct denials and the provider will need to appeal, if applicable.  

If a provider receives a “5Z” Reason Code on a claim received after February 13, 2024, that would be a correct denial and the provider will need to appeal, if applicable. 

Update February 28, 2024

Status: Palmetto GBA is continuing to adjust the “5Z” Reason Code incorrectly denied claims that were processed from February 12–23, 2024. 

For hospices, the adjustment types of bills are 81I or 82I and for HHAs it is 32I. These bill types will show on Remittance Advices once processed. 

The “5Z” Reason Codes for this issue are limited to 5Z4NH, 5Z4ND, 5Z4ON, 5Z4SR, 5Z4HS and 5Z4SO. 

Provider Action: If an HHH provider had a claim deny for another “5Z” Reason Code other than the six codes listed above or the claim was processed (shown on a Remittance Advice) prior to February 7, 2024, those were correct denials and the provider will need to appeal, if applicable.  We will provide an update once all claims are adjusted.
Update February 20, 2024

Status: Correction to the February 16, 2024, update that this issue is not limited to claims received February 8–13, 2024. 

Palmetto GBA has started the adjustments, which HHH providers will see XXI types of bills processing against the denied claim. 

Provider Action: No provider action is needed. Do not submit duplicate claims, as they will be returned. We will provide updates as soon as they are available.
Update February 16, 2024

Status: Palmetto GBA is identifying all the claims affected by this issue. Once this is completed, we will adjust the denied claims. The adjustments will start as early as the week of February 19, 2024.

Please note that this issue only affected claims received February 8–13, 2024. If a HHH provider received a claim denial with a “5Z” Reason Code prior to or after the dates listed above, the denial was correct. Providers will need to appeal those denial, if applicable.

Provider Action: No provider action is needed. Do not submit duplicate claims, as they will be returned. We will provide updates as soon as they are available.
Open February 13, 2024

Status: Palmetto GBA is researching some recently received hospice and home health (HH) claims changing the submitted Type of Bill (TOB) to XX0 (8X0 for hospice or 320 for HH), a non-pay TOB, and assigning Reason Codes that start with “5Z” to the claims. 

We have turned off the identified erroring “5Z” edits and newly submitted claims should not receive them. We are following the affected claims and determining a solution to correct them. 

Provider Action: No provider action is needed at this time. Do not submit duplicate claims, as they will be returned. We will provide an update as soon as it is available.
Issue Description
Some recently received hospice and home health (HH) claims changing the submitted Type of Bill (TOB) to XX0 (8X0 for hospice or 320 for HH), a non-pay TOB, and assigning Reason Codes that start with “5Z” to the claims. This is in research. 

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