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Last Modified: 7/18/2019 Location: FL, PR, USVI Business: Part A

Claims overlap FAQs

Q: What is an overlap?
A: When an incorrect claim is processed and posted to the Common Working File (CWF), resulting in claim overlap rejection(s) of subsequent claim(s), submitted by the same or a different provider. When more than one provider is involved, the providers must work together to resolve the error. Some overlapping claim examples include:
Same provider – dates of service overlap
Charges should be combined on one claim
Outpatient claim submitted before allowing time for inpatient claim(s) to finalize
Claims should be submitted in service date sequence
Different provider – dates of service overlap
Did not report a leave of absence on the claim
Services are subject to consolidated billing
Incorrect patient status code was submitted
Refer to resolution tips for overlapping claims, the A/B Medicare administrator contractor (MAC) collaborative job aid on how to resolve and prevent overlapping claim situations.
Source: Education Action Team
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