What to do if you did not receive an initial determination on your NOE late filing exemption request

Palmetto GBA has found that some hospice claims which requested late NOE exceptions did not receive an initial determination on the request.

At this time, no provider action is necessary to resolve this issue. Palmetto GBA is reprocessing these requests for a new initial determination and will update you on the status of the request as soon as it is available.



Providers should review the imformation form Palmetto GBA below and contact Palmetto GBA with any questions. 

The NOE late filing exception requests were processed as received. Therefore, the non-covered charges remained non-covered. 

If a hospice appealed an exception request that was not reviewed during the processing of the initial claim, the appeal submission was not a valid appeal and therefore handled accordingly and submitted for an initial determination. If the hospice then disagrees with the initial determination, all appeal rights are still available.

Please note the initial claim submission is required to follow the directions outlined in the ‘Hospice Billing When a Notice of Election (NOE) was Filed Untimely Job Aid.’ Therefore, an Occurrence Span Code (OSC) of 77 with dates, the KX HCPCS modifier and remarks are entered on the claim. If the exception was not submitted using the above direction, please adjust or resubmit your claim appropriately.

You can review the full article by Palmetto GBA here