Last Modified: 4/25/2019
Location: FL, PR, USVI
Business: Part A
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
Source: Education Action Team
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