Reason Code 38119 - 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 NO CLAIM PENDING WITH A THRU DATE 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

• Inpatient Skilled Nursing Facility (SNF) and non-Prospective Payment System (PPS) hospital bills must be processed in order services were furnished. The claim immediately preceding the dates of service on this claim has not yet processed.

Common Reason Code Corrections

• Verify submitted claim information.
  • If errors are identified, correct and F9/resubmit claim.
  • If submitted claim information is correct, submit prior month's bill.
• Wait for prior month's bill to finalize and then F9/resubmit the subsequent claim.

Resource

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

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