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Printed Date: 9/22/2015
This home health claim is a duplicate of a paid, suspended or denied home health claim for the same provider number, patient's Medicare ID number, and revenue code and line item date of service, but without a cancel date.
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. We encourage you to track submitted claims.
Reason code 38158 indicates that:
a) The claim submitted has already been paid. If changes need to be made on the original paid claim, the paid claim can either be adjusted or canceled.
b) The claim submitted is a duplicate claim of one already suspended in S status. Check the reason code on the suspended claim. Any further inquiries on the suspended claim should be directed to the Provider Contact Center at 855-696-0705. Do not submit another claim for one that is suspended.
c) The claim has been denied by medical review. A claim that has been denied may only be appealed.
Two job aids are available to assist you with determining whether a claim should be adjusted, canceled or appealed. The job aids are located under Top Links. Please notify software vendors if necessary.
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Last Updated: 01/11/2018