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Reason Code Search and Resolution

Disclaimer: This is not a complete list of reason codes.

The Reason Code Search and Resolution tool allows you to view a reason code description and determine how to prevent/resolve the edit. You may search by reason code or keyword. All records matching your search criteria will be returned for your review. You may also select "Show all Reason Codes" to view the complete list.

If the reason code you enter does not display here, you may access any reason code description in the Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE) Reason Codes Inquiry Menu (Option 17) . For additional information, please reference the FISS DDE User Manual.

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Reason Code 38031


The Fiscal Intermediary Standard System (FISS) has found a previously submitted billing transaction for the same beneficiary and dates of service with the same provider number; therefore, the second billing transaction submitted by the provider is a duplicate.


  • When using batch file transfer software, have an internal procedure in place to ensure batches of billing transactions are deleted from the software once they are submitted to Medicare.
  • Review Medicare Remittance Advice timely.
  • Stay current in posting payments received from Medicare.
  • Access the FISS Claim Inquiry Option (Option 12) to determine which claims have been submitted to Medicare. For instructions on using FISS Inquiry Option 12, see Chapter 3 - Inquiry MenuPDFof the Fiscal Intermediary Standard System (FISS) Guide.
  • Do not resubmit an identical billing transaction if you have already corrected the claim from the Return to Provider (RTP) file.
    • We encourage you to suppress the view of claims in your RTP file that you do not intend to correct. See Chapter 5 - Claims CorrectionPDFof the Fiscal Intermediary Standard System (FISS) Guide for instructions on suppressing the view of claims in RTP.
  • When appropriate, adjust rejected (R B9997) or paid (P B9997) claims instead of resubmitting them.
  • If a billing transaction needs to be cancelled and resubmitted, the original billing transaction must be in FISS status/location P B9997 prior to the submission of the cancel claim. Prior to rebilling the corrected billing transaction, the 'cancel' claim (type of bill (TOB) XX8) must also be in P B9997.
    • See Chapter 5 - Claims CorrectionPDFof the Fiscal Intermediary Standard System (FISS) Guide for detailed instructions on adjusting or canceling home health and hospice billing transactions.
  • Ensure the TOB submitted is appropriate for the billing action needed, e.g., ensure that the TOB for an adjustment ends with a '7' and not '9', etc. For a listing of the appropriate types of bills submitted to Medicare, please review the appropriate chapter of the Medicare Claims Processing ManualExternal Website (CMS Pub. 100-04) for your provider type.

Providers should be aware that duplicate billing errors impact the Medicare program negatively by increasing the cost to process Medicare claims. Providers are also negatively impacted by the consequences of duplicate billing such as:

  • Payment delays,
  • Identification as an abusive biller, or
  • The initiation of a fraud investigation if a pattern of duplicate billing is identified.

Disclaimer: CGS' online tools and calculators are informational and educational tools only, designed to assist suppliers and providers in submitting claims correctly. CGS makes no guarantee that this resource will result in Medicare reimbursement for services provided. Although we've made every reasonable effort to provide effective resources, CGS is not responsible for the consequences of any decisions or actions taken in reliance upon or as a result of the information that these tools provide. CGS is not responsible for any human or mechanical errors or omissions.


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