37253

FISS Narrative
This claim is being returned because the following criteria was met:    

Type of bill equals 327, 329 or 32Q and the Outcome and Assessment Information Set (OASIS) was not found in the Quality Improvement Evaluation System (QIES) upon receipt of this claim for a Home Health episode and the receipt date of the claim is more than 40 days after the assessment completion date.                                   

Explanation and Suggestion
Reason code 37253 indicates that home health claims with dates of service on or after April 1, 2017, that are submitted for payment will be Returned to the Provider (RTP) with Reason Code 37253 when a corresponding OASIS cannot be found in the CMS repository and the claim receipt date is more than 40 days from the OASIS completion date reported on the claim. The OASIS completion date is reported on the claim in positions 5 – 8 of the Treatment Authorization Code as reported on item M0090 of the OASIS. Positions 5 and 6 reflect the 2-digit numerical value for the year (e.g., 17 for the year 2017). Positions 7 and 8 reflect the alpha characters that equate to the month and date the OASIS was completed (e.g., 'AA' represents January 1).

Please refer to the job aid Understanding Reason Code 37253 on Home Health Claims for more information.

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