Some Claims Editing for Reason Code U537I, HH Claim Falls Outside of an HH Admission Period for the Same Provider
Home health (HH) providers in Jurisdiction 6 and Jurisdiction K
Description of Issue
Note: This issue was originally reported and resolved in April 2025. The issue has returned so we have reopened the alert.
The CWF can only hold the 36 most recent periods of care for any beneficiary. CWF also contains the indicator of when the HH admission (NOA) was processed. This indicator allows CWF to determine whether an HH admission period is on file with which claims can be associated. When HH care is continuous for more than 36 periods, the oldest period which is purged may have contained the NOA indicator. When this occurs, subsequent HH claims will be RTP with reason code U537I, “The FROM and THROUGH dates on the HH claim fall outside of an HH Admission period for the same provider.”
National Government Services Action
When notified, NGS will implement an interim workaround.
Provider Action
When a claim is returned incorrectly with reason code U537I, please notify the Provider Contact Center and they will assist with documenting the information NGS needs to update the system. After 15 days you can resubmit your claims.
Proposed Resolution/Fix
TBD