Denials

Published 03/08/2023

October – December 2022 Home Health Medical Review Top Denial Reason Codes
We encourage all providers to review this information when filing claims to prevent denials and to ensure their claims are processed timely. The following information affects providers billing 32X bill types.

32X Bill Type Denials: Total Denials 1,843

Rank

Denial Code

Denial Description

# Claims

% Claims Denied

1

56900

Auto Denial — Requested Records Not Submitted

748

40.6

2

5FF2F

Face to Face Encounter Requirements Not Met

621

33.7

3

5F023

No Plan of Care or Certification

250

13.6

4

5F041

Information Provided Does Not Support the Medical Necessity for This Service

43

2.3

5

5T070

Visits/Supplies/DME Billed Not Documented/Not Documented As Used

34

1.8

6

5T072

No Physician's Orders for Services

31

1.7

7

5F072

No Physician's Orders for Services

21

1.1

7

5A301

Information Provided Does Not Support the Medical Necessity for This Service

21

1.1

7

5T070

 

Visits/Supplies/DME Billed Not Documented/Not Documented As Used

21

1.1

10

5FT10

Documentation Does Not Support Homebound Status

17

0.9

October – December 2022 Hospice Medical Review Top Denial Reason Codes
We encourage all providers to review this information when filing claims to prevent denials and to ensure their claims are processed timely. The following information affects providers billing 81X bill types.

81X Bill Type Denials: Total Denials 853

Rank

Denial
Code

Denial Description

# Claims

% Claims Denied

1

5CNER

The Notice of Election Is Invalid Because it doesn't Meet Statutory or Regulatory Requirements

250

29.3

2

56900

Auto Denial — Requested Records Not Submitted

223

26.1

3

5FF36

Not Hospice Appropriate

178

20.9

4

5CFH9

Physician Narrative Statement Not Present or Not Valid

37

4.3

5

5CFTF

Face to Face Encounter Requirements Not Met

27

3.2

6

5CF91

Hospice GIP Reduction — Services Not Reasonable/Necessary

25

2.9

7

5CFH6

Initial Certification Not Timely

16

1.9

7

5CNOE

No Valid Election Statement Submitted

16

1.9

9

5CFH7

Subsequent Certification Not Timely

15

1.8

 

 

 


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