Avoiding Reason Code 38200

Claims are rejected with reason code 38200 when the FISS finds a previously submitted billing transaction that is a duplicate of the recently submitted billing transaction where all of the following fields on the history and processing claim are the same:

• MBI number
• TOB (all three positions of any TOB)
• Provider number
• Statement ‘from’ date of service
• Statement ‘through’ date of service
• Total charges (0001 revenue line)
• Revenue code
• HCPCS and modifiers (if required by revenue code file)

Although duplicate claim submissions will occur from time to time intentionally or unintentionally, filing duplicate claims, even if it does not result in duplicate payment, could directly or indirectly result in unnecessary costs to the Medicare Program.

How to Avoid This Reason Code

All additions and/or corrections to processed claims need to be sent on an adjustment/late charge claim. In very limited situations such as MSP rejections, the rejection claim also needs to be adjusted. Also, check the FISS/DDE Provider Online System and/or the remittance statement for the previous claim before resubmitting it.

Reviewed 5/20/2024