OPEN: Home Health Reason Code 19963, Notice of Admission Not Found

Published 03/20/2024

OPEN: Home Health Reason Code 19963, Notice of Admission (NOA) Not Found
Current Status Date  
Update March 20, 2024 Status: Palmetto GBA continues to identify additional claims that are editing for reason code 19963 improperly. We are identifying those claims that are impacted and are creating new corresponding NOAs (as described in the October 6, 2023, update) in FISS on a weekly basis. Once the new NOAs are processed, we will release the 19963 claims back into processing. This continuing issue only affects claims with admission dates in early 2022. 

Provider Action: HHAs need to ensure that their claim’s admission date matches the corresponding NOA’s “From” date for that admission. Reason code 19963 assigns correctly if: 

  • There is no NOA on file for that admission,
  • The NOA was submitted but was returned to the provider/rejected, 
  • The NOA was cancelled by the HHA and never resubmitted, 
  • The admission date does not match on the NOA and claim, or 
  • If that admission was closed by another claim with an earlier service date(s)

No provider action is needed.

Resolved December 18, 2023 Status: Palmetto GBA has completed the actions discussed in the October 6, 2023, update. 
Provider Action: No provider action is needed. If an affected NOA was omitted from Palmetto GBA’s actions to resolve this issue, it may be reported to the Provider Contact Center at 855–696–0705. 
Update October 6, 2023 Status: HHH MACs are creating new NOAs for the offline NOA’s admission periods, using the original admission date, bypassing certain edits so they do not edit as a duplicate, and entering a receipt date on the new NOA that matches the NOA statement “From” date. HHH MACs shall restore all the affected NOAs and process any associated claims returned with reason code 19963 in error within 45 calendar days of this update.
Provider Action: No provider action is needed. Palmetto GBA will provide updates when available.
Update September 27, 2023 Status: On August 23, 2023, FISS was updated to prevent additional NOAs from going offline. CMS and the MACs are working on a fix to get the claims that returned for reason code 19963 processed without provider action. 
Provider Action: No provider action is needed at this time. Palmetto GBA will provide updates when available.
Open  August 23, 2023 Status: The Home Health Medicare Administrative Contractors (MACs) are aware of some home health claims receiving reason code 19963 in error. This is occurring when the NOA is more than 18 months received by Medicare and have gone offline to OB9997 status/location. We are researching this issue and working with CMS/FISS. 
Provider Action: No provider action is needed at this time. Palmetto GBA will provide updates when available.
Issue Description
Business requirement 12227.2.4.1 of Change Request 12227 (PDF) states “On HH claims (TOB 329) where the admission date and 'From' date are not the same, the contractor (FISS) shall associate the claim to the corresponding NOA receipt date using the provider CCN and the Admission date.” When the corresponding NOA ages 18 months it automatically goes offline, it cannot be found per this business requirement and causes reason code 19963 to assign on the claim. 

 


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