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Posting Date: 06/17/2025
Holding MSP Claims Receiving CWF Edit 6802
Certain MSP claims are incorrectly rejected against CWF edit 6802. On 4/24/2025, CMS directed MACs to hold all MSP claims editing with 6802 while CWF works to correct the issue.
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Posting Date: 09/21/2020
Interactive Voice Response System
Interactive Voice Response System State IVR Number Hours Available* Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, Vermont 877-567-7205 Monday–Friday: 6:00 a.m.–7:00 p.m. ET [...]
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Posting Date: 04/22/2021
Provider Contact Center
Provider Contact Center Table of Contents Want to talk to us? Make the Most of Your Call Customer Care Representative Assistance Interactive Voice Response System NGSConnex Online Inquiry System Freedom of Information Act (FOIA) [...]
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Posting Date: 04/01/2020
EDI Help Desk Information
EDI Help Desk Information Toll-Free Number Jurisdiction 6: 877-273-4334 Jurisdiction K: 888-379-9132 Hours of Operation Monday–Friday: 8:00 a.m.–5:00 p.m. ET * Closed for training on the 2nd and 4th Friday of the month from 12:00–4:00 [...]
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Posting Date: 06/01/2018
Avoiding Reason Code 38200
Avoiding Reason Code 38200 Claims are rejected with reason code 38200 when the FISS finds a previously submitted billing transaction that is a duplicate of the recently submitted billing transaction where all of the following fields on the [...]
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Posting Date: 07/14/2024
Correcting Reason Code 37253
Correcting Reason Code 37253 To ensure home health claim information aligns with OASIS data, the iQIES OASIS claim data match is essential. If no matching assessment is found in iQIES when a claim is submitted, it will be returned with reason [...]
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Posting Date: 05/08/2023
Home Health Billing When a New MBI is Assigned
Home Health Billing When a New MBI is Assigned A patient’s MBI number is required on all home health billing submitted to Medicare. CMS will issue a new MBI when an original MBI may have been, or has been compromised. There are times a home [...]
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Posting Date: 01/13/2022
Billing the Home Health Notice of Admission Electronically
Billing the Home Health Notice of Admission Electronically Table of Contents Billing the Home Health Notice of Admission Electronically NOA Claim Page 1 NOA Claim Page 2 NOA Claim Page 3 NOA Claim Page 4 NOA Claim Page 5 [...]
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Posting Date: 12/30/2022
Telehealth Home Health Services
Telehealth Home Health Services Prior to 1/1/2023, data on telecommunications technology used during a 30-day period of care at the patient level was not collected on HH claims. On 7/1/2023 reporting telecommunications G codes became [...]
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Posting Date: 11/21/2024
Incarcerated or Unlawfully Present in the U.S. Claim Rejections (U538H, U538Q)
Incarcerated or Unlawfully Present in the U.S. Claim Rejections (U538H, U538Q) This stringent claim editing process helps ensure that Medicare does not make payments for services rendered to beneficiaries who are not eligible due to being [...]
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Posting Date: 07/14/2024
Expanded Home Health Value-Based Purchasing Model
Expanded Home Health Value-Based Purchasing Model Overview The HHVBP Model is an initiative by CMS aimed at improving the quality of care provided by home health agencies while also fostering greater efficiency. It builds on the original [...]
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Posting Date: 02/04/2022
Notice of Admission Questions and Answers
Notice of Admission Questions and Answers Medicare requires HHAs to submit a one-time NOA instead of RAPs for new admissions starting on or after 1/1/2022. HHAs shall no longer submit RAPs, TOB 0322 for any HH periods of care with a “From” [...]
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Posting Date: 05/19/2022
Billing the Home Health Period of Care Claim - PDGM
Billing the Home Health Period of Care Claim – PDGM Table of Contents Billing the Home Health Period of Care Claim – PDGM Claim Page 1: Claim Page 2: Claim Page 3 Claim Page 4 Claim Page 5 Related Resources [Return to Top] [...]
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Posting Date: 05/19/2022
Home Health Third Party Liability Demand Billing
Home Health Third Party Liability Demand Billing Table of Contents Background What is a Demand Bill? Requirements for Submission How to Submit a TPL Demand Bill Claim Page 1: Claim Page 2 – Covered and Noncovered Charges Claim [...]
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Posting Date: 01/13/2022
Billing the Home Health Notice of Admission via DDE
Billing the Home Health Notice of Admission via DDE Table of Contents Billing the Home Health Notice of Admission via DDE NOA Claim Page 1 NOA Claim Page 4 Notes Related Content [Return to Top] Billing the Home Health [...]
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Posting Date: 02/26/2016
Reporting Home Health Periods with No Skilled Visits
Reporting Home Health Periods with No Skilled Visits Eligibility for the Medicare HH benefit requires that the beneficiary have a need for intermittent skilled nursing care, PT, SLP, or a continuing need for OT. The need for skilled care makes [...]
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Posting Date: 04/11/2017
Billing G-Codes for Therapy and Skilled Nursing Services
Billing G-Codes for Therapy and Skilled Nursing Services Table of Contents Billing G-Codes for Therapy and Skilled Nursing Services What You Need to Know to Bill Physical Therapy Occupational Therapy Speech Language Pathology [...]
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Posting Date: 07/21/2022
Late Notice of Admission - The Exception Process
Late Notice of Admission - The Exception Process Table of Contents Timeliness of the NOA and the Penalty Requirements for Submission of the NOA Exception Process Canceling a Timely NOA to Correct an Error Reasons Not to Cancel an NOA [...]
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Posting Date: 05/09/2022
Home Health Transfers
Home Health Transfers Table of Contents Background What To Do As a Receiving HHA What To Do As the Initial HHA What To Do In Case of a Dispute Related Content [Return to Top] Background A home health transfer occurs when a [...]
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