January to March 2023 Home Health Medical Review Top Denial Reason Codes

Published 08/08/2023

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.

Rank Denial Code Denial Description # Claims % Claims Denied

1

56900

Auto Denial — Requested Records not Submitted

870

38.2

2

5FF2F

Face-to-Face Encounter Requirements Not Met

809

35.5

3

5F023

No Plan of Care or Certification

282

12.4

4

5F041

Information Provided Does Not Support the Medical Necessity for This Service

60

2.6

5

5T072

No Physician's Orders for Services

46

2.0

6

5F070

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

45

2.0

7

5F301

Information Provided Does Not Support the Medical Necessity for Therapy Services

34

1.5

8

5t070

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

31

1.4

9

5F072

No Physician's Orders for Services

29

1.3

10

5A301

Information Provided Does Not Support the Medical Necessity for Therapy Services

22

1.0

 


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