Traditional MedicareAdministrativeMedium impact
R13996OTN: Home Health Reason Code 19963 Edit – Notice of Admission Not Found
Medicare/CMS - Transmittals·CMS Transmittal
Effective date
Apr 1, 2027
We identified it
Oct 10, 2026
Summary
CMS is implementing a technical correction to home health claim processing for reason code 19963 edits. Starting April 1, 2027, Medicare Administrative Contractors must accept home health claims (TOB 032x) with dates of service within 24 months of admission even if received after 24 months, when Notice of Admission records have been purged from the system. This prevents valid claims from being erroneously rejected due to data retention limitations.
Action Required
By April 1, 2027: Home health billing teams should verify that claims with dates of service within 24 months of admission are no longer being rejected with reason code 19963 edits, even if the claim is received after 24 months of the admission date. Confirm with your Medicare Administrative Contractor (MAC) that the technical correction has been implemented in claims processing systems. No manual workflow changes are required for providers; this is a contractor-level system update. If claims continue to be rejected under these conditions after April 1, 2027, contact your MAC's Contracting Officer's Representative (COR) to report the issue.