U538I

FISS Narrative
A home health Request for Anticipated Payment (RAP) or claim overlaps an existing episode with a different provider number. This error most commonly occurs when a beneficiary elects to transfer from one HHA to another during a 60 day episode and the receiving HHA submits their initial episode RAP/claim without a condition code 47 to indicate a transfer between HHAs.

Explanation and Suggestion
Prior to admission or submitting RAPs/claims to Medicare, check the beneficiary's eligibility file to review established home health episodes for beneficiary which may impact your dates of service. If the beneficiary is transferring to your HHA, you may refer to the Medicare Benefit Policy Manual, 100-2, Chapter 7, Section 10.8E and Medicare Claims Processing Manual, 100-4, Chapter 10 Section 10.1.15 & 20.1.1.

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