Reason Code 38119

Description
Inpatient Skilled Nursing Facility (SNF) and Non-Prospective Payment System (PPS) hospital bills must be processed in the same sequence in which the services were furnished. The claim immediately preceding the dates of service on this claim has not yet processed.

Resolution

  • This reason code occurs when SNF inpatient claims are "out of sequence"
  • The claim receiving this reason code does not directly follow the thru date of the previous paid claim for this Medicare beneficiary from this provider
  • In many instances, the claim that breaks the sequential chain may be in process (check the Claims Inquiry screen #12 for a claim in Status S or T)
  • If so, the current claim cannot continue processing until the "in sequence" claim is paid (you receive the claim on a remittance advice)
  • If the "in sequence" claim is not already in FISS, it must be submitted and paid before the current claim can process
Reference: CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 1 (PDF, 1.61 MB), section 50.2.1.