Denial Code 19963_Notice of Admission (NOA) Not Found

This denial indicates one of the following:

1.     Medicare has received a final claim, and no NOA exists; or

2.     The original NOA is more than 18 months received by Medicare and has gone "offline."  This is a common issue with Medicare.  If the claim denies for this reason, you will need to contact Medicare or follow their current guidance on getting claim adjudication. Information may be found on the Palmetto GBA > Claims Payment Issues Log.

Suggestions to resolve this denial:

1.     Verify an NOA was submitted.  If it has not, submit NOA.  Then resend the final claim.  Include KX modifier with reason, if applicable.

2.     Verify the admission date on the claim matches the admission date on the NOA.  If it does not, correct then resend the EOE.

3.     Verify if the NOA was cancelled, for some reason, but never resubmitted.  Follow process to resend NOA, then send the final claim with KX modifier, if applicable.

4.     IMPORTANT:  Verify the NOA was accepted by Medicare.  If the NOA was not accepted by Medicare,  you will not receive an EOB.  It is important to monitor the status of the NOA until it receives the "paid" status, to avoid untimely filing due to denials or rejections.

Click here for information on KX modifier.

Denial Code 38107_Home Health final claim submitted; however, a processed, matching RAP (Request for Anticipated Payment) cannot be found.  (Prior to 2022)

This denial reason indicates one of the following:

1.     Medicare has received a final claim, and no RAP exists; or

2.     One of the following fields on the EOE do not match to the RAP

a.     the HIPPS code

b.     the line item date for the HIPPS code

c.     the Statement From Date

d.     the Admission date

e.     the Provider number

Click here for details on Reason Code 38107.

Suggestions to resolve this denial:

1.     Verify that a RAP has been submitted for the episode:

a.     If a RAP has been submitted, make sure that Medicare has not recouped the payment, due to timeliness of submitting the EOE.  

b.    If there is no RAP, submit the RAP for payment.  Once Medicare pays towards the RAP, you can “update” the claim in DDE.  (See KB article:  Updating a Claim in "T" status)

2.    Make sure that all the required fields match on the RAP and EOE claim.  Make the needed corrections and “update” the claim in DDE.  (See KB article:  Updating a Claim in "T" status)

**Note:  These steps are pertinent to RAPs with dates of service prior to 2022.