Home Health & Hospice Week

A new claims glitch may be adding to your Pre-Claim Review confusion — and delaying your reimbursement.

“Providers under Review Choice Demonstration (RCD) who chose PCR for their selection must submit claims with a valid unique tracking number (UTN) to receive payment,” HHH Medicare Administrative Contractor Palmetto GBA says on its website. “Exceptions to this rule are made if the beneficiary is currently involved in a demonstration program such as the Accountable Care Organization (ACO) or Bundled Payments for Care Improvement Initiative (BPCI) demonstrations. This reason code indicates that if you are in one of these demonstrations, you should remove the UTN and resubmit the claim without it.”

The problem: “Claims with valid UTN’s for benefi­ciaries that are not under a demonstration have been receiving the reason code 39621 edit in error,” Palmetto reports.

The solution: Palmetto is monitoring the issue, and “claims that are editing for this reason code in error will be suspended in status location SMWORK until a fix is installed” on Nov. 1, the MAC says. “Claims that are correctly editing for this reason code will … Return to Provider (RTP),” it adds. “Please review and update any claims that correctly RTP for Reason Code 39621.”