Production Alert Details

U537F Assigning in Error On Some Notices of Admission

Date Reported:
Date Updated:
Date Resolved:
Provider Types Impacted:

Jurisdiction 6 and Jurisdiction K Home Health providers

Reason Code(s):
Claim Coding Impact:

Description of Issue

National Government Services has identified an issue where U537F is assigning incorrectly on some NOAs, due to the CWF not correctly recognizing discharges (patient status other than 30 on the last HH period). There is no workaround.

Please note: This edit will also assign correctly on duplicate NOAs for the same admission period. Please ensure an NOA is not already in the system pending processing or finalized prior to submitting a new NOA for a beneficiary. Home health agencies should not be submitting multiple NOAs for same admission.

The U537F edit will also assign correctly on NOAs if the provider CCN does not match the CCN on the prior HH episode posted at CWF. In this situation, the NOA should be billed with a condition code 47.

National Government Services Action

The CWF maintainer has developed a fix for this issue.

Provider Action

Update as of 7/22/2022: Providers are advised to routinely verify billing before submitting a new NOA for a beneficiary admission. Effective 4/25/2022, providers can resubmit any HH NOAs (32A) that have returned to provider incorrectly and are advised to bill the KX modifier on the final HH period of care claim(s) affected by the late NOA. The claim(s) should also include Remarks to request an exception to the late-filing penalty. These remarks can be similar to ‘Late NOA due to System Issue with Reason Code U537F.'

Proposed Resolution/Fix