OPEN: Incarceration Claim and Notice Rejections, Reason Code U538H
Published 08/28/2024
| OPEN: Incarceration Claim and Notice Rejections, Reason Code U538H | ||
|---|---|---|
| Current Status | Date | |
| Open | August 28, 2024 |
Status: CMS and CWF are researching to determine how to correct the incarceration date for impacted beneficiaries and process claims that rejected in error or have been suspended. Palmetto GBA is currently suspending affected claims and HHH notice of admissions/elections to status/location (S/LOC) S MOSUI until the issue is resolved. Some claims and notices may have rejected prior the implementation of the suspension. Correcting the rejections will be part of the resolution. |
| Provider Action: No action is needed at this time. Palmetto GBA will provide updates when available. | ||
| Issue Description | ||
| An Eligibility Database update that incorrectly identifies some beneficiaries as incarcerated caused the Common Working File (CWF) to reject claims and home health/hospice (HHH) notice of admissions/elections in error. They are rejecting incorrectly with reason code U538H for "SERVICES BILLED WHILE BENEFICIARY IS INCARCERATED." | ||
Article Update Notification
Would you like to know when this article is updated? Sign up for Article Update Notifications below and we'll send you an email with the new version automatically.
Please check your spam/junk folder as your notification email maybe delivered there.