NGS Update: Some Home Health Medicare Claims Editing for Reason Code U537I

The Situation Report | June 9, 2025

National Government Services (NGS), New York’s principal Medicare Administrative Contractor (MAC) for Home Health and Hospice, reports that a claims editing error issue, that was originally reported and resolved in April 2025, has returned and is being worked on by NGS once again. 

Issue

The Common Working File (CWF) can only hold the 36 most recent periods of care for any beneficiary. The CWF also contains the indicator of when the home health (HH) Notice of Admission (NOA) was processed. This indicator allows CWF to determine whether an HH admission period is on file with which claims can be associated. When HH care is continuous for more than 36 periods, the oldest period which is purged may have contained the NOA indicator. When this occurs, subsequent HH claims will be returned to provider (RTP) with reason code U537I, “The FROM and THROUGH dates on the HH claim fall outside of an HH Admission period for the same provider.”

NGS Fix

NGS has scheduled a fix for this issue on June 16, 2025, which will allow claims to process correctly.  When a home health Medicare claim is returned incorrectly with reason code U537I, providers should resubmit the returned claim(s) after 6/16/2025.

For any questions, please contact HCANYS Vice President of Finance and Management Patrick Conole.