OPEN: Some Claims Editing for Reason Code U537I, Home Health Claim Falls Outside Admission Period for Same Provider

Published 04/08/2025

OPEN: Home Health (HH) — Some Claims Editing for Reason Code U537I, HH Claim Falls Outside of an HH Admission Period for the Same Provider
Current Status Date  
Open  March 11, 2025 Status: This issue is in research.
    Provider Action: No provider actions are needed currently. We will provide an update as soon as it is available. 
Issue Description
This issue affects HH claims for patients that have been on HH for 37 or more consecutive periods in a single admission. The Common Working File (CWF) can only hold the 36 most recent periods of care for any beneficiary. Periods that precede the most recent 36 will be dropped off the file and are not retrievable online. When the admission period drops from CWF (also drops from the beneficiary’s eligibility record), claims for periods 37 and later cannot find the admission period and the claim is returned to provider (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.” 
 

 


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