Reason Code 38005 - JF Part A

Reason Code Narrative

THIS CLAIM IS A DUPLICATE OF A PREVIOUSLY SUBMITTED INPATIENT CLAIM. THE FIRST TWO POSITIONS OF THE TOB ARE 11X, 18X OR 41X AND THE FOLLOWING FIELDS ON THE HISTORY AND PROCESSING CLAIM ARE THE SAME HIC NUMBER, PROVIDER NUMBER, STATEMENT FROM DOS, STATEMENT THRU DOS, REVENUE CODE, HCPCS, AND MODIFIER(S) (IF REQUIRED BY REVENUE CODE FILE).

Common Reason Code Errors

• The claim is a duplicate of a previously submitted inpatient claim.
• Claim matches another claim already submitted, based on various criteria such as the patient's Medicare number, provider number, type of bill, statement coverage dates, diagnosis, line-item date of service, revenue code, HCPCS code, and total charges.

Common Reason Code Corrections

• Verify claim status of original claim to ensure it has been processed correctly.
• Avoid duplicate submissions by ensuring you are not resubmitting the same claim.
  • If the claim includes repeat services or supplies, append appropriate modifiers and/or condition codes.
• Use the Direct Data Entry (DDE) to access the beneficiary's Medicare number to verify the history of claims submitted and their status.
• Review remittance advice for a history of the beneficiary's claims.

Resources

• CMS Medicare Learning Network MLN006926 - Medicare Billing: CMS-1450 and 837I
• Noridian Direct Data Entry (DDE) User's Manual for Medicare Part A