Reason Code 38117 - JE Part A

Reason Code Narrative

THE TOB IS EQUAL TO AN SNF OR CLAIM IS FOR A NON-PPS INPATIENT AND THE ADMISSION DATE IS ON OR AFTER 040195 AND THE STATEMENT COVERS FROM DATE IS GREATER THAN THE ADMISSION DATE, THERE IS A PRIOR CLAIM PENDING, AND THE PRIOR CLAIM'S THRU DATE IS 1 DAY LESS THAN THIS CLAIM'S FROM DATE AND THE REASON CODE AUTHORIZATION FIELD (CLAIM PAGE 9) DOES NOT CONTAIN THIS REASON CODE.

Common Reason Code Errors

• Claim was submitted out of sequential date order (e.g. February claim was submitted prior to January claim).
• Two claims were submitted and processing at same time. (e.g. Both January and February claims were submitted and processing on same date).

Common Reason Code Corrections

• Verify that claims have processed in sequential order. If they have, resubmit next claim in order. Direct Data Entry (DDE) users may F9 the claim.
• If claims have processed out of sequential order, cancel claims that are out of sequential order (e.g. If February claim is paid, but January claim still needs to be submitted, February would need to be cancelled before January will process).

Resource

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 6, Section 40.1

View reason code list, return to Reason Code Guidance page.