Home Health Agency - Most Common Denial Reasons

See below for the most common denial reasons - home health agency.

Error 0542 - Member Ineligible Serv Date

Error: The member is not eligible for MassHealth on the date of service entered on the claim.

Resolution: To avoid this error, always verify member eligibility before or on the date of service.

Error 0850 - Billing Deadline Exceeded - Detail

Error: MassHealth allows 90 days from the date of service or dates of explanation of benefits (EOB) to submit the initial claim to MassHealth. Claims submitted after 90 days will deny for this error.

Resolution: Providers should follow the procedures to obtain a 90-day waiver as outlined in Subchapter 5 of the Home Health Agency Manual, when applicable.

Error 3121 - Invalid Referral Number

Error: The Primary Care Clinician (PCC) referral number entered on the claim does not match the PCC number on the member's file.

Resolution: Use the Eligibility Verification System (EVS) to verify the name and telephone number of the member's PCC. Then contact the PCC to obtain the correct referral number. It is important to verify this information for each date of service as the member's PCC may change.

Error 5050 - Exact Duplicate Home Health Claim

Error: The claim submitted is a duplicate of a claim previously paid for the same member, pay-to provider number, date of service, and service code. Some software systems will automatically generate "tracers" for claims that have not been posted.

Resolution: To avoid this error, post claims from your remittance advice in a timely manner to avoid rebilling previously paid claims.

Errors 5065 - 5069 - Conflict of Services on the Same Day

Error: The service code entered on the claim conflicts with services billed on previous and current claims provided on the same date of service entered on the claim.

Resolution: Verify the service date submitted on the claim. To avoid this error in the future, post claims from your remittance advice in a timely manner to avoid rebilling previously submitted claims.


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