Reason Code U538I
A home health RAP or claim overlaps an existing episode with a different provider number. This error most commonly occurs when a beneficiary elects to transfer from one HHA to another during a 60-day episode and the receiving HHA submits their initial episode RAP/claim without a condition code 47 to indicate a transfer between HHAs.
Prior to admission or submitting RAPs/claims to Medicare, check the beneficiary's eligibility file to review established home health episodes for beneficiary, which may impact your dates of service.
If the beneficiary is transferring to your home health agency, follow the steps for appropriately completing beneficiary elected transfers as outlined in the:
- Medicare Benefit Policy Manual (Pub. 100-02, Ch. 7, §10.8E — PDF)
- Medicare Claims Processing Manual (Pub. 100-04, Ch. 10, § 10.1.15 and § 20.1.1 — PDF)
If the information displayed for the other provider is their National Provider Identifier (NPI), use the National Plan and Provider Enumeration System (NPPES) website to determine their contact information. To access contact information for other home health providers when a Provider Transaction Access Number (PTAN) is displayed, visit the CMS website. Scroll down and click on "HHA-Reports Zip File" to open a zip file that contains a listing of home health provider ID information. To indicate a beneficiary has transferred to your HHA, enter a condition code "47" in the first available COND CODES field (FL 18–28) on FISS page 01.