Home Health Medical Review Top Denial Reason Codes for October to December 2023

Published 03/11/2024

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 2,169

Rank Denial Code Denial Description # Claims % Claims Denied
1 56900 Auto Denial — Requested Records Not Submitted 1,223 56.4
2 5FF2F Face-to-Face Encounter Requirements Not Met 480 22.1
3 5F023 No Plan of Care or Certification 234 10.8
4

5FNOA

Unable to Determine Medical Necessity of HIPPS Code Billed as Appropriate OASIS Not Submitted 53 2.4
5

5F301

Information Provided Does Not Support the Medical Necessity for Therapy Services 31 1.4
6

5A301

Information Provided Does Not Support the Medical Necessity for Therapy Services 29 1.3
7 5F041 Information Provided Does Not Support the Medical Necessity for This Service 25 1.2
8 5T070 Visits/Supplies/DME Billed Not Documented/Not Documented As Used 22 1.0
9 5F072 No Physician's Orders for Services 16 0.7
10 5T072 No Physician's Orders for Services 15 0.7

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