Reason Code Narrative

INPATIENT PPS CLAIM WITH THRU DATE EQUAL TO INPATIENT PPS FROM DATE.

Common Reason Code Errors

• Claim resubmission after a payment has been taken back.
• Beneficiary readmitted to inpatient care at a different facility later in same day.
• Wrong patient status was chosen for discharge.

Common Reason Code Corrections

• Verify dates are correct with other facility.
• Verify and correct patient discharge status to reflect appropriate discharge.

Noridian Medicare Portal (NMP) is the best resource for preemptive and remedial action on these claims. The eligibility functions of inpatient/Skilled Nursing Facility (SNF), Home Health Episode History (HHEH), and Hospice will need to be verified.

Remember to use an additional 72 hours in the From/To search field to account for Home Health.

Check with the beneficiary, the Interactive Voice Response (IVR) System, or in the Noridian Medicare Portal (NMP) for the patient’s discharge history. If another facility has a patient status code that is causing the error, their contact information can be found by entering the NPI through the National Plan and Provider Enumeration System (NPPES).

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