Reason Code C7080 - JE Part A

Reason Code Narrative

An outpatient claim has a from/thru date that overlaps an inpatient claim and the provider number is different.

OR

A Home Health claim has a detail line item date of service (LIDOS) that overlaps an inpatient, Religious Non-Medical Health Care Institution (RNHCI), or Skilled Nursing Facility (SNF) claim on history and the provider number is different.

Common Reason Code Errors

• Outpatient or Home Health LIDOS overlap an inpatient stay and should be billed to inpatient facility;
• Outpatient or Home Health LIDOS billed incorrectly; or
• Repetitive services billed without occurrence span code 74 and inpatient dates of service (DOS)

Common Reason Code Corrections

Review patient's eligibility using Noridian Medicare Portal (NMP) or Interactive Voice Response (IVR) to determine overlapping date

If other facility must update their date of service

• NMP or IVR will return National Provider Identifier (NPI) of overlapping facility
• Copy/write down NPI
• In a browser window, navigate to National Plan and Provider Enumeration System (NPPES) website
• Search NPI to display facility name and contact information
• Reach out to facility to request they update their claim

If requiring a LIDOS correction

• Submit an adjustment through Direct Data Entry (DDE)
• Use type of bill (TOB) XX7
• Correct applicable LIDOS
• Add remarks to explain adjustment
• Select most appropriate adjustment reason code

If charges should be bundled in an inpatient stay

• Submit charges to inpatient facility
• If not already in place, create a payment arrangement
• Inpatient facility will need to pay provider of outpatient or Home Health services directly

If requiring a claim adjustment to add the 74 occurrence span code

• Submit an adjustment through Direct Data Entry (DDE)
• Use type of bill (TOB) XX7
• Add occurrence span code 74 and use from/through dates of service for overlapping inpatient claim
• Add remarks to explain adjustment
• Select most appropriate adjustment reason code

Resources

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 10, Section 30.9
• CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 1, Section 50.2.2

View reason code list, return to Reason Code Guidance page.