31755

FISS Narrative
This reason code will be assigned if home health type of bill 3x2 or 3x9 is entered and the one of the following criteria is not a match:

  • If the admission date of the claim is equal to the statement from date, the earliest 0023 line date should also be equal
  • Revenue code 0023 was not found
  • If final, each 0023 service date must equal a visit service date for the 0023 span

Explanation and Suggestion
Either:

  • The 'From and Thru' dates and admission date on the RAP are the same. Therefore, the 0023 line item Service Date must also match.
  • The final claim does not have a visit that corresponds to the date shown on the 0023 line item service date (the first billable visit)
  • The RAP is missing the revenue code 0023 and line item service date

Review the RTP’d RAP in the Direct Data Entry (DDE) system.

  • Does the Statement From and Thru Date (Field 6) match the Admission Date (Field 17)?
    • If yes, select 03 Corrections in DDE, access the RAP and change the 0023 line item Service Date (Field 45) to the same date, F9 the claim
    • If 0023 line item Service Date is missing from the claim, it can be added and then F9 the claim
  • Is there a visit on the final claim that matches the 0023 line item service date?
    • If no, verify that the 0023 line item service date is correct (first billable visit)
    • Select 03 Corrections in DDE, access RTP’d claim and add visit to the final claim, and correct total charges
    • If 0023 line item service date on the RAP is incorrect: cancel the processed RAP. Once the processed RAP is canceled, resubmit a new RAP.

Contact Palmetto GBA JM Part HHH Medicare

Email HHH

Contact a specific JM HHH department

Provider Contact Center: 855-696-0705

TDD: 866-830-3188

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