12205

FISS Narrative
The year in the statement covers "From" field is not the same as the year in the statement covers "Through" field. Please verify the statement covers period. Where the "From" and "Through" years are different, submit a separate claim for each year.

Explanation and Suggestions:

  • This reason code is generated when the "From" and "Through" date on an outpatient claim overlap the calendar year end
  • Because Medicare outpatient deductible and coinsurance amounts are based upon the calendar year, it is not acceptable for the dates of service on an outpatient claim to overlap the calendar year end
  • You must split-bill all outpatient services that overlap the calendar year
  • Correct and resubmit the claim. Hard copy submitters, please resubmit the RTP report with corrections.

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