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Last Modified: 1/6/2012
Location: FL, PR, USVI
Business: Part A
38005
This claim is a duplicate of a previously submitted inpatient claim. The first two positions of the type of bill (TOB) are 11x, 18x or 41x and the following fields on the history and processing claim are the same:
• Health insurance claim (HIC) number
• Provider number
• Statement "From" date of service (DOS)
• Statement "Thru" DOS
• Revenue code
• HCPCS and modifiers (if required by revenue code file)
Resources/tips to avoid or correct this reject code
Verify the status of your claims before refiling. There are several ways to verify this information:
• You can use the beneficiary health insurance claim (HIC) number to obtain a history of the claims you have submitted and the status/location of the claims using the direct data entry (DDE) 
claims inquiry function.
claims inquiry function.• Review the weekly 201 report available via DDE.
• Review the remittance advice.
There may be times you submit your claims through your software and use the electronic data interchange (EDI) gateway . Once you submit your claims electronically, the EDI gateway will send you a confirmation on the batch of claims received. Please wait on a confirmation prior to resubmitting the batch of claims. If you make one change to one claim in the batch and resend, the EDI gateway will allow the claims to go to the fiscal intermediary standard system (FISS), resulting in duplicate claims.
. Once you submit your claims electronically, the EDI gateway will send you a confirmation on the batch of claims received. Please wait on a confirmation prior to resubmitting the batch of claims. If you make one change to one claim in the batch and resend, the EDI gateway will allow the claims to go to the fiscal intermediary standard system (FISS), resulting in duplicate claims.Note: Duplicate claims are caused by resubmission of claims after payment has been made on an initial claim. This could potentially result in duplicate payments. Billing that appears to be a deliberate application for duplicate payment of services or supplies may be considered fraud under the provisions of the Medicare program. Errors that have been brought to a facility’s attention must be corrected.
Please use your browser's back button to return to the referring page.Source: FCSO Education Action Team
