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
Q: Why is my claim overlapping another facility’s when my dates do not fall within their dates of service?
A: The facility with the claim for the earliest dates of service may have billed an incorrect patient discharge status code. Applying the correct patient status code will help assure that the facilities receive prompt and correct payment.
• If your patient status code is incorrect, it can indicate a patient is still in your facility when, in fact, they were discharged and admitted to another facility. It is recommended that you submit an adjustment to update the patient status on your claim.
• If the other facility has submitted an incorrect patient status code, it is recommended that you contact the other facility and ask them to update the patient status code on the claim.
• Example: The claim indicates that the patient is still in the facility (patient status 30), but the patient was transferred to a Medicare certified Skilled Nursing Facility (patient status 03).
Q: I have contacted the overlapping facility numerous times and have asked them to correct their claim, but the claim has not been corrected. What steps can be taken to get the other facility’s claim updated?
A: While providers/facilities are required and expected to work together to resolve the billing issue, providers may occasionally require assistance from the Medicare Administrator Contractor (MAC). In that case, First Coast will work with both providers/facilities for resolution.
For further assistance with these claims, write in to the First Coast claims department: In order for your request to be considered, supporting documentation must be included with your written request to:
Medicare Part A
P.O. Box 2711
Jacksonville, FL 32231-0021
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
Q: Why is my claim overlapping another facility’s when my dates do not fall within their dates of service?
A: The facility with the claim for the earliest dates of service may have billed an incorrect patient discharge status code. Applying the correct patient status code will help assure that the facilities receive prompt and correct payment.
• If your patient status code is incorrect, it can indicate a patient is still in your facility when, in fact, they were discharged and admitted to another facility. It is recommended that you submit an adjustment to update the patient status on your claim.
• If the other facility has submitted an incorrect patient status code, it is recommended that you contact the other facility and ask them to update the patient status code on the claim.
• Example: The claim indicates that the patient is still in the facility (patient status 30), but the patient was transferred to a Medicare certified Skilled Nursing Facility (patient status 03).
Q: I have contacted the overlapping facility numerous times and have asked them to correct their claim, but the claim has not been corrected. What steps can be taken to get the other facility’s claim updated?
A: While providers/facilities are required and expected to work together to resolve the billing issue, providers may occasionally require assistance from the Medicare Administrator Contractor (MAC). In that case, First Coast will work with both providers/facilities for resolution.
For further assistance with these claims, write in to the First Coast claims department: In order for your request to be considered, supporting documentation must be included with your written request to:
Medicare Part A
P.O. Box 2711
Jacksonville, FL 32231-0021
