Reason Code 37402

Description
A hospice claim was submitted, but the previous claim is not found OR there is a gap between the “To” date of the previous claim and the “From” date on the next claim.

Resolution
Hospice claims must be submitted sequentially. This means that January's claim, for example, must be submitted before February's claim can be submitted.

Check the FISS Claim Inquiry Option (Option 12) to determine if the prior claim was submitted.

Example Below: No prior claim in FISS.

If prior claim was submitted, ensure it is in a "P," "D" or "R" status code before submitting the next claim.

Example below: Prior claim in "T" status; not "P," "D" or "R" as required.

• Hospice claims must also be submitted consecutively. This means that there cannot be any skip in dates between the prior claim's "To" date, and the next month's claim's "From" date; and
• Verify there is no gap between the "To" date on the previous claim and the "From" date on the next claim.

Example below: Gap in dates between prior claim's "To" date (0429YY) and next claim's "From" date (0501YY). 
 

In addition, Hospices are required to bill claims monthly (see Medicare Claims Processing Manual (CMS Pub. 100-04), Ch. 11, §90 — PDF). This means providers should bill only one claim per month, for each patient. The "To" date on the claim must be the last calendar day of the month, unless the patient died, was discharged or revoked hospice during the month.

In addition, hospice claims must conform to a calendar month (January 1–31). Claims that span two months (January 1 to February 1, for example) will be sent to the RTP file for you to correct.

Note: You must correct the claims out of Return to Provider (RTP) file sequentially. For example if the January claim is in RTP because of an invalid HCPC code, and the February claim was submitted, the February claim would go to RTP because no prior claim was found. You must first correct the January claim. Once the January claim is corrected and moves to a suspended status/location, the February claim can be F9'ed out of RTP.

Additional resources: Medicare Claims Processing Manual (CMS Pub. 100-04), Ch. 1, §50.2.3 (PDF).