RESOLUTION UPDATE: Home Health: Some Claims Editing for Reason Code U537I, HH Claim Falls Outside of an HH Admission Period for the Same Provider

Status: On June 16, 2025, Medicare performed a utility to find beneficiaries with 36 periods on file for continuous HH admission with the same agency without a Notice of Admission (NOA) indicator on any of the periods. When located, a NOA indicator was added to the oldest period on the Common Working File (CWF) (the April 21, 2025, fix will ensure NOA indicator periods will stay on file). 

Starting the week of June 23, 2025, Palmetto GBA will reenter into processing the claims that edited/returned for Reason Code U537I with admission dates from January 1, 2022, to April 21, 2022, and claim ‘From’ dates on or after January 1, 2025. If a home health agency (HHA) has a claim that returned for Reason Code U537I and it does not meet date ranges mentioned, please see the below.

Reason code U537I is a valid code and will assign correctly if:

• Another HHA admitted the beneficiary and submitted a NOA with Condition Code 47, ending the previous admission.
• The admission date does not match on the NOA and claim.
• There is no admission on file for the beneficiary and HHA.
• The NOA was submitted but was returned to the provider/rejected.
• The NOA was cancelled by the HHA and never resubmitted.
• That admission was closed by another claim with an earlier service date(s).

If reason code U537I assigns for one of the above reasons, the HHA must resolve the edit by taking the appropriate actions.

Provider Action: No provider action is required, and providers no longer need to email or contact the Provider Contact Center (PCC) to report the issue.

Providers that return their claims for processing prior to Palmetto GBA reentering them will not be reentered by Palmetto GBA.

Provider Action: This issue affected claims with admission dates from January 1, 2022, and prior to April 21, 2022, and 37 or more consecutive periods in a single admission, with the same HHA, on a beneficiary’s eligibility record. If an HHA has a claim that meets the above criteria and it edited for U537I, you may email a spreadsheet to the Provider Contact Center at General.PRRS@palmettogba.com.

Required elements of email with spreadsheet:

• Email subject line: Some Claims Editing for Reason Code U537I, Home Health Claim Falls Outside Admission Period for Same Provider

Spreadsheet Columns:

• MBI
• Date of Birth
• Name of Beneficiary
• NPI
• PTAN
• Last five digits of the TIN
• Date of Service

Note: Allow up to 15 business days before submitting claims and/or adjusting.