Having Trouble with Claim Denials with Reason Code 37253

This is because no matching OASIS was found and the claim receipt date is more than 40 days after the OASIS completion date. In most cases, these claims cannot be resubmitted for payment and the revenue is lost.

Medicare posted CR9585 on October 27, 2016 letting agencies know that a new edit was being put into place to enforce the OASIS as a condition of payment. The first phase of this was put into place back in 2015 when they made sure the payment group codes on the claim matched those submitted on the OASIS. The new edit that took effect on April 1, 2017 now enforces the reporting regulation that requires the OASIS to be transmitted within 30 days of completing the assessment of the beneficiary although the initial edit will allow for 40 days.

If your agency is struggling with this requirement HealthWare has the answer for you with our OASIS Validation Reporting Import feature. Not a fancy name, but it automates what you must otherwise do manually with your OASIS Validation Reports and helps to make sure that you can track OASIS that has not been submitted and validated and that you cannot submit a claim until it has been. Let HealthWare help you visiting our website at https://www.healthware.com/contactus or call us at 850-479-9035.

Review CR9585 at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3629CP.pdf