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Home Health & Hospice Week

Industry Note:

Payment System Glitch Returns Claims Incorrectly

Published on Tue Jul 26, 2011

Look over your returned claims carefully if they've been RTP'd with reason code 31018 or 12207. "When a claim is being fully denied or rejected, FISS is changing the 'from' date on the claim to match the 'admit date' on the claim," HHH Medicare Administrative Contractor CGS says in a message to providers. "As a result, claims are receiving reason code 31018 and 12207 in error." Background: Home health claims receive reason code 31018 when there is more than a span of 60 days between the 'FROM' and 'TO' date submitted or when there are fewer than 60 days between the 'FROM' and 'TO' date submitted and the patient's status code reflects '30' on the claim, HHH MAC Palmetto GBA explains on its website. Reason code 12207 applies to hospice claims, explains MAC Noridian. Once the problem is fixed, CGS will correct your RTP'd claim automatically if it has received [...]
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