Reason Code 38055

FISS Narrative
A home health (32X, 33X or 34X) or CORF claim (75X) was submitted as a Medicare primary claim and contains exact service dates corresponding to a previously submitted home health or CORF claim for the same provider with at least one matching revenue code and the incoming claim. Tape to tape flag is not equal to a "Z." This reason code will not be assigned if the revenue/lab HCPC line contains a HCPC modifier equal to "QR" or CPT modifier "91."

Explanation and Suggestion
This is one of several reason codes that indicates that a duplicate claim has been received in the Medicare claims system or FISS. Providers are encouraged to track submitted claims.

Reason code 38055 indicates that the claim submitted has exact service dates and at least one revenue code that overlaps a previously submitted claim. Providers should check the status and location of the previously submitted claim before attempting to correct, resubmit, adjust or cancel the claim.  

Two job aids are available to assist providers with determining whether a claim should be adjusted, canceled or appealed. The job aids are located under Learning and Education; select Job Aids. Notify software vendors if necessary.