What it means on your remittance
The home-health twin of ESC 928: no EVV visit record matched this home-health claim line. Same published causes — visit never sent, visit arrived after the claim, visit stuck Incomplete, or a mismatch on date of service, recipient RID, procedure code, or provider MPI. The 9-digit-MA-ID-instead-of-10-digit-RID trap applies here too.
Why it happens
- Same causes as ESC 928, on home-health lines: no visit sent, visit arrived after the claim, visit stuck Incomplete, or a mismatch on date of service, recipient RID, procedure code, or provider MPI.
- The 9-digit MA ID used where the 10-digit RID is required — the trap applies to home health exactly as to personal care.
How to fix it, step by step
- 1Verify the recipient ID is the 10-digit RID.
- 2Confirm the visit is Verified in the aggregator before the claim goes out — home-health visits race claims just as often as personal-care ones.
- 3Match date of service, procedure code, and 9-digit MPI field by field against the visit.
- 4Correct the failing element, re-verify, resubmit.
How to tell it apart
A prior version of this page described 938 as a 'manual edit flagged' code — that was wrong. Per the DHS ESC table, 938 is the home-health twin of 928: no matching EVV visit found. Pennsylvania tracks manual edits through its quarterly 85% compliance measure, not through this ESC.
Note: state edit codes like this one often appear on the paper Remittance Advice rather than inside the 835 file. If you only have the 835, our team can read the full remittance for you.
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Run the free Denial X-RayCommon questions
What does denial ESC 938 mean?
The home-health twin of ESC 928: no EVV visit record matched this home-health claim line. Same published causes — visit never sent, visit arrived after the claim, visit stuck Incomplete, or a mismatch on date of service, recipient RID, procedure code, or provider MPI. The 9-digit-MA-ID-instead-of-10-digit-RID trap applies here too.
How do I fix a ESC 938 denial?
Work it exactly like a 928: verify the 10-digit RID, confirm the visit is Verified in the aggregator before billing, and match date, procedure code, and 9-digit MPI. Fix the mismatch, re-verify, resubmit.
Is 938 handled differently from 928?
The diagnosis and fix are identical — 928 fires on personal-care service lines, 938 on home-health lines. Pennsylvania publishes them as parallel codes ten apart (925→935, 926→936, 927→937, 928→938).