38107

FISS Narrative
Either:
  1. An HH final (TOB 329 or 339) is being processed and an HH rap (TOB 322 or 332) does not exist
  2. One of the following fields on the final (TOB 329 or 339) do not match to the RAP:
    • Statement from date
    • Admission date
    • HIPPS code
    • Line item date for the HIPPS code (0023 revenue line date)
    • Provider number
Explanation and Suggestion
The system cannot find a processed RAP that corresponds to the final claim. This could occur when either:
  • No RAP has been submitted
  • Your processed RAP auto-canceled due to untimely filing of the final claim (60 days from paid date of the RAP or 120 days from the start of care) 
  • The processed RAP has fields which do not match the fields in your final claim
Correcting Your Claim
  • Verify in the Direct Data Entry (DDE) system if there is a processed RAP
  • If there is not a RAP in the system, bill the RAP. When the RAP posts to the Common Working File (CWF):
    • In DDE, select 03 corrections, access the RTP’d final claim and F9 the claim
  • If there is a RAP, does it show a cancel date? This could mean that the RAP was auto-canceled (in CWF, the episode will show a patient indicator 1). If the RAP was canceled, resubmit the RAP.
  • If there is a processed RAP, ensure that the RAP and final claim information match in these fields:
    • Statement FROM date
    • Admission date
    • HIPPS code
    • 0023 revenue code line
    • Item service date (Field 45)
  • If the RAP information is correct, make the necessary changes on the final claim in ‘T’ status and F9 the claim
If the final claim information is correct, cancel the processed RAP. Once this processes, resubmit a new RAP with information that matches the final claim.

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