544- Addressing Billing Rejections for Overlapping Claims (F51)

On 1/21/2025, an 'In the Loop’ article was distributed to notify users of an upcoming change to the overlap billing edits. Effective 2/6/2025, the overlap (F51) billing edit will no longer apply to service coordination, social work, transportation, or respite claims. As a result, general service claims with the same date and time as these service types will no longer receive an F51 rejection: 'Claim Start and End Time cannot overlap with another claim'. Please note, overlaps exceeding 9 minutes between other service types will continue to be rejected unless there is an approved co-visit for both services authorizations as per the Individualized Family Service Plan and they are claimed appropriately as co-visits.   

If you received an F51 rejection due to an overlap with a service coordination, social work, transportation, or respite claim, you may rebill the claim(s). Follow the steps below based on your billing method:

• For Service Logging providers: On 2/6/2025, PCG will perform a one-time rebill for Service Logging billing providers whose claims were rejected due to the F51 edit. This rebill will include service coordination, social work, respite, and transportation claims rejected for F51, as well as claims rejected due to overlaps with these service types.

i  Along with the billing edit change, Service Logging has been updated to remove the overlap check. As a result, providers will no longer receive overlap notifications when generating claims in Service Logging. This applies to all overlaps, including those caused by duplicate claims for the same child. Overlap validations for Service Logging claims will now occur during the daily billing validation in Case Management, when claims transition from Service Logging to Case Management before being placed on a voucher. For an overview of the Service Logging claiming process flow, please reference this infographic.

• For 837 Billing providers: Providers must resubmit claims rejected due to F51. PCG is unable to generate the 837 file on their behalf.

To address F51 billing rejections going forward, the PCG Call Center will be able to identify the billing providers with the overlapping claims. Beginning 2/10/2025, agents can provide details on time-in and time-out entries for claims submitted for a child on the same day, enabling faster, first-point resolution.

Did you know?  A Rejections Guide is available to assist users in understanding the reasons for common claims rejections and provide the steps for addressing them. Click the link below to access the guide.   

Claims Rejection Guide