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Last Modified: 2/21/2011
Location: FL, PR, USVI
Business: Part A
38109
The following conditions have occurred:
• The incoming type of bill equals 11X and the prior type of bill equals 13X or 85X
• The special program code is not equal to 'A6'
• The prior claim revenue codes do not equal 29X, 54X, 960, 961, or 969
• The incoming statement covers to date does not equal the prior statement covers from date
• The incoming statement covers from date is not greater than the prior statement covers from date
• The incoming statement covers to date is greater than the prior statement covers from date
• The incoming provider number (first nine positions only)
Resources/tips to avoid or correct this reject code
As the definition of the reason code shows, the inpatient claim has overlapped with a claim for PPV/Medicare Pneumococcal Pneumonia/Influenza 100% payment.
The inpatient claim should have an 'A6' condition code to override this reason code on the claim.
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Source: FCSO Education Action Team
