Reason Code: 38031

Error Description:

Hospice: This outpatient claim is a possible duplicate to a previously submitted outpatient claim and the following conditions exist:

1. Statement ‘from’ and ‘through’ dates overlap
2. Provider numbers are the same
3. At least one revenue code line matches
4. The diagnosis code(s) on both the history and incoming claim are the same
5. If the history or incoming claim has one of the following HCPCS modifiers LT, RT, E1‒E4, FA, F1‒F9, TA or T1‒T9 for the same HCPCS, and same date of service, and the incoming or history claim has a blank HCPCS modifier, or the HCPCS modifier isn’t equal to LT, RT, E1‒E4, FA, F1‒F9, TA or T1‒T9
6. At least one HCPCS code is the same on both claims or
7. If HCPCS modifier (LT, RT, E1‒E4, FA, F1‒F9, TA or T1‒T9) are equal on both the incoming and history claim, the reason code will assign

Avoiding/Correcting This Error

Verify the ‘from’ and ‘through’ dates, provider number, revenue codes, HCPCS codes, and line item date of service on the bill.

If the claim is truly a duplicate; no action is necessary. Providers should develop and implement a process to ensure that duplicate claims are not being submitted.

If all information is correct, add the charges from the incoming claim to those of the paid claim by submit an adjustment to the processed claim.