July - September 2021, Home Health Medical Review Top Denial Reason Codes

Published 11/29/2021

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 the 32X bill type.

There were a total of 1,252 claims denied for 32X bill type.

Rank

Denial Code

Denial Description

# Claims

% Claims Denied

1

56900

Auto Denial — Requested Records Not Submitted

574

45.8

2

5FF2F

Face-to-Face Encounter Requirements Not Met

373

29.8

3

5F023

No Plan of Care or Certification

193

15.4

4

5T070

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

22

1.8

5

5FNOA

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

9

0.7


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