Reason Code 38107

Published 12/16/2019

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


  • 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)

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