Home Health: Reason Code U5391, Fields on the Requests for Anticipated Payments (RAPs) and Final Claim Information Do Not Match

Current Status

Date

Resolved

2/17/2021

Status: When agencies use the new exception from MLN/CR 11855 and submit RAPs with the first day of the period of care as the service date on the 0023 line for subsequent periods in CY 2021, the corresponding claim must be submitted with the same 0023 line date. The service dates on 0023 of the RAP and claim must match.

Provider Action: Providers shall enter the same service date on the 0023 line from the RAP to the corresponding claim 0023 line and return the claim for processing. Agencies should ensure the additional items detailed in reason code 38107 also match.

Open

2/8/2021

Status: Palmetto GBA is researching the editing of Reason Code U5391 for appropriateness, which is returning home health claims to the agency

Provider Action: If a RAP has processed, ensure the statement “from” date, admission date, HIPPS code, line item date for the HIPPS code (if not reporting the first day of the period on the RAP in CY 2021) and provider number on the claim match the RAP. No provider action is necessary at this time. We will provide updates when applicable.

Issue Description

Reason Code U5391 is editing on home health claims.

The reason code states:

One of the following fields on the final (TOB 329 or 339) do not match to the RAP.

1)  statement “from” date

2)  admission date

3)  HIPPS code

4)  line item date for the HIPPS code (0023 revenue line date)

5)  provider number

This issue may be caused by the CY 2021 changes in MLN 11855, which allows line item date for the HIPPS code to be the first day of the period of care as the service date on the 0023 line.