Reason Code 38107

Description
Home health final claim submitted; however, a processed, matching RAP cannot be found.

Resolution

• Prior to submitting the final claim, access FISS Claim Inquiry option (Option 12) to determine if the RAP is in FISS status/location (S/LOC) P B9997
  • You should not submit the final claim for the episode unless the RAP is in this S/LOC
• Review your Medicare Remittance Advice timely to verify the RAP has completed processing
• Submit the final claim prior to the greater of 60 days from when the RAP paid or the end of the episode
• Prior to submitting the final claim, ensure the RAP has not auto-canceled
  • Step 1: Access FISS Inquiry Option 12
  • Step 2: Enter your HHA's National Provider Identifier in the NPI field
  • Step 3: Enter the beneficiary's Medicare number in the MID field
  • Step 4: Enter P B9997 in the S/LOC field
  • Step 5: Enter 328 in the TOB field
  • Step 6: Enter your episode's start date in the “From” date field
  • Step 7: Press Enter
  • FISS will return a listing of billing transactions that meet the criteria entered
  • If a 328 type of bill is displayed, tab down to it and key an "S" in the “SEL” field
    • Press Enter
    • Press your F8 key to page forward to FISS Page 03
    • Review the information in the ADJUSTMENT REASON CODE field at the bottom of the screen
    • If the letters NF appear in this field, FISS auto-canceled your RAP because the final claim was not received timely
    • If your RAP auto-canceled, rebill the RAP and wait for it to process (P B9997)
    • Submit the final claim for the episode
  • If FISS does not return a 328 TOB, press your F3 button and follow Steps 1 through 7
    • If FISS still does not return a 328 TOB, then your RAP did not auto-cancel
    • Submit the final claim for the episode
  • Prior to submitting the final claim, ensure that the key information, listed below, for the episode's RAP and claim matches
  • Provider number/identifier of the billing home health agency (FL 56)
  • "From" date of the episode (FL 6)
  • Date of admission (FL 12)
  • First four positions of the Health Insurance Prospective Payment System (HIPPS) code (FL 44)
    • If the fifth position of the HIPPS code needs to change based on the provision of non-routine supplies, your HHA should ensure that the supply severity level between the RAP and final claim for the same episode of care does not change
  • Date of service billed with the HIPPS code (FL 45)