Reason Code 11503 - JE Part A
Reason Code 11503
Reason Code Narrative
THE DATE OF ADMISSION IS GREATER THAN 30 DAYS AFTER THE THROUGH DATE OF THE QUALIFYING STAY. HOWEVER, NEITHER CONDITION CODE 55, 56 OR 57 ARE PRESENT. VERIFY THE QUALIFYING STAY DATES SUBMITTED. ** IF QUALIFYING STAY DATES ARE INCORRECT, SUBMIT AN XX7 ADJUSTMENT, CORRECTING THE CLAIM AND QUALIFYING STAY DATES, TO THE INTERMEDIARY.
Common Reason Code Errors
- The qualifying hospital stay (Occurrence Span Code 70) is more than 30 days from Skilled Nursing Facility (SNF) or Swing Bed (SB) admission date.
- Subsequent claims (213, 214, 183, and 184) Types of Bills (TOBs) that continue the billing sequence, will also reject, if the first bill in the sequence has rejected with Reason Code 11503.
Common Reason Code Corrections
Adjust the claim coding if one of the below condition codes is appropriate.
- Condition code 55 (SNF Bed Not Available) the patient's SNF admission was delayed more than 30 days after hospital discharge because a SNF bed was not available.
- Condition code 56 (Medical Appropriateness) the patient's SNF admission was delayed more than 30 days after hospital discharge because the patient's condition made it inappropriate to begin active care within that period.
Condition code 57 (SNF Readmission) the patient previously received Medicare covered SNF care within 30 days of the current SNF admission.
- The 78 occurrence span code may be needed if the patient was transferred from a different SNF to your facility.
- If the 70 occurrence span code is missing or incorrect, adjust the claim to correct the qualifying stay.
- CMS Internet Only Manual (IOM), Medicare Benefit Policy Manual, Publication 100-02, Chapter 8, Section 20.2.2
- CMS IOM, Medicare Claims Processing Manual, Publication 100-04, Chapter 6
View reason code list, return to Reason Code Guidance page.
Last Updated Wed, 26 Feb 2020 14:56:59 +0000