July to September 2023 Home Health Medical Review Top Denial Reason Codes

Published 11/30/2023

We encourage all providers to review this information when filing claims to prevent denials and to ensure their claims are processed timely. The following information affects providers billing 32X bill types.

Rank

Denial Code

Denial Description

# Claims

% Claims Denied

1

56900

Auto Denial — Requested Records not Submitted

1,103

41.7

2

5FF2F

Face to Face Encounter Requirements Not Met

733

27.7

3

5F023

No Plan of Care or Certification

334

12.6

4

5F041

Information Provided Does Not Support the Medical Necessity for This Service

79

3.0

5

5FNOA

Unable to Determine Medical Necessity of HIPPS Code Billed as App Oasis Not Submitted

67

2.5

6

5F301

Information Provided Does Not Support the Medical Necessity for Therapy Services

59

2.2

7

5F070

Visits/Supplies/DME Billed Not Documented/Not Documented As Used

55

2.1

8

5A301

Information Provided Does Not Support the Medical Necessity for Therapy Services

42

1.6

9

5T070

Visits/Supplies/DME Billed Not Documented/Not Documented As Used

37

1.4

10

5F072

No Physician's Orders for Services

35

1.3


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