Reason Code 38105

Reason Code Narrative

WHETHER ANY REV CODE LINES ARE EQUAL OR NOT, OUTPATIENT TYPES OF BILLS (13X,14X,83X OR 85X) CANNOT HAVE OVERLAPPING DATES WHEN THE PROVIDER NUMBERS ARE EQUAL UNLESS:

  • ONE OF THE CLAIMS IS FOR A PAP SMEAR ONLY
  • ONE OF THE CLAIMS IS FOR MAMMOGRAPHY SCREENING ONLY
  • THE OUTPATIENT CLAIM HAS A SPAN CODE 74 AND THE ASC CLAIM HAS A DATE OF SERVICE WITHIN THE SPAN CODE 74 DATES
  • THE 14X AND 83X ARE FROM A MARYLAND WAIVER PROVIDER (MWI=Y) AND THE 14X CONTAINS LAB ONLY AND THE 83X DOES NOT CONTAIN LABS.
  • ONE OF THE CLAIMS IS FOR REPETITIVE PART B SERVICES ONLY FOR CAH (85X) TYPE OF BILL.

Common Reason Code Errors

  • Provider is submitting multiple claims with non-repetitive services for overlapping dates of service
  • If an original type of bill is submitted and dates of service overlap an already paid claim, it will be Returned To Provider (RTP)

Common Reason Code Corrections

  • Non-repetitive services must be billed on one claim for overlapping dates of service. Any late charges must be added through an adjustment of original claim

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

Last Updated Oct 19, 2018