An overlap is 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, which is the A/B and home health and hospice (HHH) MAC collaborative job aid on how to resolve and prevent overlapping claim situations.
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