Home Health Claims Returning to Provider RC 19963

Description of Issue

HH claims are returning to provider in error with RC 19963. This impacts HH claims with NOA/processed dates in January 2022. NOAs are being purged after 24 months. Please keep in mind there are claims that edit correctly for this reason code. RC 19963 assigns correctly if:

• There is no NOA on file for that admission,
• The NOA was submitted but was rejected/RTP
• The NOA was cancelled by the home health agency (HHA) and never resubmitted,
• The NOA and claim admission dates do not match, or
• The admission was closed by another claim with an earlier service date.

National Government Services Action

A fix has been scheduled for October 2024. An interim fix has been implemented which is not retroactive. Claims that already hit the edit continue to require manual correction; the provider action below is still necessary for those claims.

Upon notification from the provider, National Government Services will create new NOAs for offline NOA admission periods using the original admission date and bypassing certain edits so as not to edit as duplicates, and entering a receipt date on the new NOA that matched the NOA statement “From” date. NGS will process any associated claims that returned with RC 19963 in error

Provider Action

No change to provider action, continue following these instructions: If you identify NOAs/claims that are incorrectly returning to provider for RC 19663, please call the NGS PCC. The PCC will send the applicable claims RTP for RC 19663 to the NGS Claims Department to have the NOA added back onto the system and reprocess all associated 19963 RTP claims. Providers with multiple claims that have rejected for RC 19963 should add them to a spreadsheet with the MBI, DOS and DCN and call the PCC to get a reference number to fax the spreadsheet into the PCC. 

Proposed Resolution/Fix

A fix has been scheduled for October 2024, please watch for additional Email Updates.