Q: What steps can be taken to identify claims that overlap with another provider?



A: If you receive an overlap reason code, you can do one of the following:

• Verify your claims submitted through direct data entry (DDE) pdf file

• Option -1 (inquiry menu), then option -12 (claims summary), and key in the beneficiary’s health insurance claim (HIC) number, your provider number, and press enter

• Review the list of claims submitted to identify those with identical dates of service, and validate they were submitted accurately

• Verify eligibility for home health episodes and hospice election from the ELGA and/or ELGH screens

• Verify the beneficiary/eligibility tab submenu on the secure provider online tool (SPOT)

• Home health episode start and end date, and the servicing provider’s NPI

• Hospice election effective and termination date, revocation code and the servicing provider’s NPI

• Click here to learn more about the SPOT

• NPI registry lookup external link enables you to search for the provider’s information

• Verify additional eligibility information from the submenu on the interactive voice response (IVR)

Hospice effective and termination dates (if applicable), and the servicing provider’s ID

• Home health effective and termination dates (if applicable), and the servicing provider’s ID

• Skilled nursing facility (SNF) effective and termination dates (if applicable), and the servicing provider’s ID

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