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

  • 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 billing sequence, will also reject, if first bill in sequence has rejected with Reason Code 11503

Common Reason Code Corrections

  • Adjust claim coding if one of below condition codes is appropriate
    • Condition code 55 (SNF Bed Not Available) 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) patient's SNF admission was delayed more than 30 days after hospital discharge because patient's condition made it inappropriate to begin active care within that period
    • Condition code 57 (SNF Readmission) patient previously received Medicare covered SNF care within 30 days of current SNF admission
      • The 78 occurrence span code may be needed if patient was transferred from a different SNF to your facility
  • If 70 occurrence span code is missing or incorrect, adjust claim to correct qualifying stay

Resources

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

 

Last Updated Aug 20, 2018