NGS Update on Home Health Claims Being Returned for Reason Code U5371

The Situation Report | April 28, 2025

National Government Services (NGS), New York’s principal Medicare Administrative Contractor (MAC) for home health providers in Jurisdiction 6 is reporting that the common working file (CWF) can only hold the 36 most recent periods of care for any home health Medicare beneficiary.

CWF also contains the indicator of when the home health notice of admission (NOA) was processed. This indicator allows CWF to determine whether an home health admission period is on file with which claims can be associated. When home health care is continuous for more than 36 periods, the oldest period which is purged may have contained the NOA indicator. When this occurs, subsequent home health claims are being incorrectly returned to provider (RTP) with reason code U537I, “The FROM and THROUGH dates on the claim fall outside of an home health admission period for the same provider.”

NGS has now installed a correction and the previous “interim workaround” is no longer needed.  Certified Home Health Agencies (CHHAs) should resubmit any claims that were incorrectly returned to provider for the U5371 reason code.