Reason Code Descriptions
- U5565: Admission date does not match election period start date.
- U5566: Admission date does not match election period start date on adjustment claims.
Why These Reason Codes Occur
These reason codes are assigned when the admission date reported on an interim or final hospice claim does not match the hospice election period start date recorded on the beneficiary’s Medicare eligibility file.
Hospice providers are required to submit the admission date using the same effective date as the beneficiary’s hospice election. This requirement also applies to transfer claims, which must continue to use the original election date maintained on the beneficiary’s eligibility record.
These edits became effective on April 1, 2026, and apply to claims with dates of service on or after that date.
How to Resolve Reason Codes U5565 and U5566
To correct these claim rejections:
- Access the beneficiary’s eligibility information through eServices or another Medicare eligibility system.
- Verify the current hospice election period start date.
- Compare the election date with the admission date reported on the claim.
- Correct any discrepancies.
- Resubmit the claim for processing.
Accurate alignment between the admission date and election period start date helps prevent claim denials and ensures proper Medicare reimbursement.
References
MLN Matters Number: MM14227 (PDF)
Provides guidance regarding the new long-term hospice stay edit implemented to prevent Medicare overpayments.
Change Request 14227 (PDF):
Explains the system changes associated with the hospice long-term stay edit and outlines claim processing requirements.
Additional Requirement
Business Requirement 14227.1 states that contractors will return TOBs 813, 814, 823, and 824 to providers and reject adjustment claims when the admission date does not match the election period start date associated with the beneficiary’s election record.