Correcting Reason Code 37253

An essential step in ensuring the information on a home health claim matches the OASIS supporting the home health agency’s billing is the iQIES OASIS claim data match. If there is no matching assessment found in iQIES when a claim is submitted, the HHA’s claim will be returned with reason code 37253. There are several areas that need to be verified to help correct/avoid this error. If a claim gets returned for this reason code, please use the following questions as a checklist to ensure all areas have been verified and corrected:

• Have you checked your iQIES verification report to confirm the receipt date was accepted prior to submitting your claim? This is on Page 1 of the report under “Completion Date/Time.”  
  • If the OASIS was submitted after the claim, resubmit the claim.
• Have you verified the assessment hasn’t been inactivated?
  • If the assessment was inactivated, resubmit the assessment.
• Have you verified the reason for assessment (from M0100) is equal to 01, 03, 04 or 05? The date reported under occurrence code 50 must match an applicable assessment.
  • If the assessment to which the claim is matched is not one with an appropriate reason for assessment, update occ 50 to match the M0090 date of the appropriate assessment.
  • If there is no occurrence code 50 on the claim, correct and resubmit.
• Have you verified your provider number, the beneficiary Medicare number and the assessment completion date match on the assessment and claim?
  • If any items do not match, correct the assessment or claim and resubmit.
• Have you verified the MBI reported on the OASIS and claim?
  • If the MBI has changed, verify the MBI in M0063 on the OASIS matches the MBI submitted on the claim.
• If you have verified all of this information and have proof of verification, you will need to contact the Provider Contact Center and be ready to send the claim DCN, Page 1 of the OASIS validation report and any other pages showing the reason for assessment, the patient’s Medicare number and the date of the assessment (M0090), as well as the assessment ID number and your state.

Please note: it is not appropriate to send an insurance denial (with condition code 21) when a claim is assigned the 37253 reason code. Submitting the claim with condition code 21 would result in inappropriate beneficiary liability. You must follow the steps outlined above to correct the RTP in order for the claim to process correctly.

Please refer to MLN Matters® SE20010: Ensure Required Patient Assessment Information for Home Health Claims for more information.