April 14, 2017
Increase in Duplicate Billing of UTN
CGS is receiving an increased volume of final claims from Home Health Agencies that contain UTNs previously billed for an affirmed beneficiary, but are being rebilled with a different beneficiary’s final claim. CGS is also seeing instances where claims with initial and subsequent episodes of care are being billed with the same UTN.
Reminder: UTNs affirmed via PCR submission must match the beneficiary, PTAN, NPI, episode dates of care and HCPCS codes that were approved on the PCR request that is associated with the final claim being billed. The same UTN cannot be submitted for multiple episodes of care or multiple beneficiaries. UTNs included on claims for which there is no associated PCR request may be subject to additional medical review.