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Last Modified: 4/25/2019 Location: FL, PR, USVI Business: Part A

Claims overlap FAQs

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:
Verify your claims submitted through direct data entry (DDE) pdf file
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
Click here to learn more about the SPOT
NPI registry lookup external link enables you to search for the provider’s information
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 review the IVR operating guide
Click here to access the listings for all hospice, home health, and SNF providers; along with the provider’s ID, name and address
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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First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.