Last Modified: 4/25/2019
Location: FL, PR, USVI
Business: Part A
Q: What steps can be taken to identify claims that overlap with another provider?
A: If you receive an overlap reason code, you can do one of the following:
• Option -1 (inquiry menu), then option -12 (claims summary), and key in the patient’s Medicare number, your provider number, and press enter
• Review the list of claims submitted to identify those with identical dates of service, and validate they were submitted accurately
• Verify eligibility for home health episodes and hospice election from the ELGA and/or ELGH screens
• Verify the beneficiary/eligibility tab submenu on the secure provider online tool (SPOT)
• Home health episode start and end date, and the servicing provider’s NPI
• Hospice election effective and termination date, revocation code and the servicing provider’s NPI
• Verify additional eligibility information from the submenu on the interactive voice response (IVR)
• Hospice effective and termination dates (if applicable), and the servicing provider’s ID
• Home health effective and termination dates (if applicable), and the servicing provider’s ID
• Skilled nursing facility (SNF) effective and termination dates (if applicable), and the servicing provider’s ID
• Click here
to access the listings for all hospice, home health, and SNF providers; along with the provider’s ID, name and address
Source: Education Action Team
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