Duplicate Edits

110.2.3 - Duplicate Edits (Rev. 1757, Issued: 06-19-09, Effective: 07-20-09, Implementation: 07-20-09) Effective April 1, 2002, CWF implemented the following duplicate edits for A/B MAC (B) submitted claims. A. Edit 7253 - Part B Ambulance Claim Against an Outpatient Part B SNF Ambulance Claim on History Reject if a Part B claim is received with ambulance codes per the files supplied to CWF in the annual and quarterly updates and the Date of Service equals the Date of Service on an outpatient Part B SNF (23x) claim with revenue code 54x (ambulance). Bypass the edit if either the incoming or history claim contains any of the following situations: • The claim is a CANCEL ONLY (Action Code 4) claim. • The claim is denied. • The incoming claim payment process indicator is other than A (allowed). B. Edit 7257 - A/B MAC (B) or DME MAC or A/B MAC (A) Part B Claim Against An Inpatient B SNF (22x) Claim on History Reject as a duplicate claim if an A/B MAC (B) or DME MAC Part B claim or A/B MAC (A) Part B claim (12x, 13x, 14x, 23x, 33x, 71x, 73x, 74x, 75x, 76x, 83x or 85x) is received containing date of service, HCPCS code and modifier if present, equal to the date of service, HCPCS code and modifier, if present, on an inpatient Part B SNF (221, 222, 223, 224 or 225) claim. Bypass the edit if either the incoming or history claim contains any of the following situations: • The claim is a CANCEL ONLY (Action Code 4) claim. • The claim is denied. • HCPCS code is not present on the A/B MAC (A) claim. • The A/B MAC (B) Part B claim payment process indicator is other than A (allowed). • For the A/B MAC (B)/DME MAC claim only, the Part B claim contains only separately payable services per the files supplied to CWF in the annual and quarterly updates.