Reason Code: 38105
Error Description:
Regardless of whether any revenue code lines are equal or not, outpatient TOB 13X, 14X, 83X, or 85X cannot have overlapping DOS when the PTANS are equal. There are a few exceptions such as when:
- One of the claims is for a pap smear only
- One of the claims is for mammography screening only
- The outpatient claim contains OSC 74 and the other claim has a DOS within the OSC 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) TOB
Avoiding/Correcting This Error
Verify billing and if appropriate, correct and resubmit the claim.
To prevent this error on future claims: Ensure that the correct bill type is submitted once you have received all charges from all departments and that no claim has been submitted for the same DOS and beneficiary, as applicable, prior to submitting a claim for payment. Ensure that the correct TOB is used. Utilize the IVR system, NGSConnex or FISS to determine whether a claim has already been submitted for this date of service.