OPEN: Home Health Reason Code 19963, Notice of Admission Not Found

Published 08/30/2024

OPEN: Home Health Reason Code 19963, Notice of Admission (NOA) Not Found
Current Status Date  
Update August 30, 2024

Status: On July 18, 2024, CMS issued Change Request 13684, Revisions to Home Health Edit Matching Claims to Notices of Admission, with an implementation date of January 6, 2025. The purpose of this Change Request (CR) is to ensure home health claims submitted more than 24 months from the date of admission are not returned in error due to Notice of Admission records being purged from the Fiscal Intermediary Shared System.

Until the implementation of CR 13684, Palmetto GBA will continue to identify additional claims that are editing for reason code 19963 improperly. We are identifying those claims that are impacted and are creating new corresponding NOAs (as described in the October 6, 2023, update) in FISS on a weekly basis. Once the new NOAs are processed, we will release the 19963 claims back into processing.
Provider Action: HHAs need to ensure if reason code 19963 did edit correctly and if applicable, take appropriate action. See the March 20, 2024, provider action for the situations reason code 19963 correctly edits on a claim.
Update June 14, 2024

Status: CMS is creating a fix for this issue that is scheduled to be put into production in the January 2025 System Release. 

This issue generally affects claims received by Medicare 18 months after the corresponding NOA was processed. For example:

  • The NOA admission date is May 2, 2022; and 
  • The NOA completed processing on May 14, 2022; and 
  • A claim for this admission was received on March 2, 2024, more than 18 months after the NOA processed;
  • The claim would likely edit for 19963

Palmetto GBA will continue to identify additional claims that are editing for reason code 19963 improperly. We are identifying those claims that are impacted and are creating new corresponding NOAs (as described in the October 6, 2023, update) in FISS on a weekly basis. Once the new NOAs are processed, we will release the 19963 claims back into processing.

Once Palmetto GBA creates a new corresponding NOA for a beneficiary, that should allow additional claims received later to process and not edit for 19963.
Provider Action: As stated in the March 20, 2024, update, HHAs need to ensure if reason code 19963 did assign correctly and if applicable, take appropriate action. 
Update March 20, 2024 Status: Palmetto GBA continues to identify additional claims that are editing for reason code 19963 improperly. We are identifying those claims that are impacted and are creating new corresponding NOAs (as described in the October 6, 2023, update) in FISS on a weekly basis. Once the new NOAs are processed, we will release the 19963 claims back into processing. This continuing issue only affects claims with admission dates in early 2022. 

Provider Action: HHAs need to ensure that their claim’s admission date matches the corresponding NOAs “From” date for that admission. Reason code 19963 assigns correctly if: 

  • There is no NOA on file for that admission;
  • The NOA was submitted but was returned to the provider/rejected;
  • The NOA was cancelled by the HHA and never resubmitted; 
  • The admission date does not match on the NOA and claim; or 
  • If that admission was closed by another claim with an earlier service date(s)

No provider action is needed.
Resolved December 18, 2023 Status: Palmetto GBA has completed the actions discussed in the October 6, 2023, update. 
Provider Action: No provider action is needed. If an affected NOA was omitted from Palmetto GBA’s actions to resolve this issue, it may be reported to the Provider Contact Center at 855–696–0705. 
Update October 6, 2023 Status: HHH MACs are creating new NOAs for the offline NOA’s admission periods, using the original admission date, bypassing certain edits so they do not edit as a duplicate, and entering a receipt date on the new NOA that matches the NOA statement “From” date. HHH MACs shall restore all the affected NOAs and process any associated claims returned with reason code 19963 in error within 45 calendar days of this update.
Provider Action: No provider action is needed. Palmetto GBA will provide updates when available.
Update September 27, 2023 Status: On August 23, 2023, FISS was updated to prevent additional NOAs from going offline. CMS and the MACs are working on a fix to get the claims that returned for reason code 19963 processed without provider action. 
Provider Action: No provider action is needed at this time. Palmetto GBA will provide updates when available.
Open  August 23, 2023 Status: The Home Health Medicare MACs are aware of some home health claims receiving reason code 19963 in error. This is occurring when the NOA is more than 18 months received by Medicare and have gone offline to OB9997 status/location. We are researching this issue and working with CMS/FISS. 
Provider Action: No provider action is needed at this time. Palmetto GBA will provide updates when available.
Issue Description
Business Requirement 12227.2.4.1 of Change Request 12227 (PDF) states “On HH claims (TOB 329) where the admission date and 'From' date are not the same, the contractor (FISS) shall associate the claim to the corresponding NOA receipt date using the provider CCN and the Admission date.” When the corresponding NOA ages 18 months it automatically goes offline, it cannot be found per this business requirement and causes reason code 19963 to assign on the claim. 

 


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