CMS Pub. 100-04, ch. 1, § 70.8.2

There are no prescribed reasons other than those aforementioned for splitting claims and

for counting additional claims into your workload. However, claims are frequently split

for other reasons that are dictated by the systems or the methods of processing them.

Such additional claims are labeled "Replicate Claims." Tally and report all replicate

claims (other than those aforementioned) separately. Identify replicate claims and report

them in the appropriate categories for claims. Some examples of replicate claims are:

• Additional claims created because of a line item limitation (regardless of the

methodology used for coding line items);

• Extra claims created in making partial payments;

• Claims created for carving out individual specialty types of services and

• Extra claims created to apply special payment reductions (e.g., Gramm-Rudmann-Hollings) efficiently for applicable dates of service.

NOTE: For budget requests and cost reports (CMS-l524, CMS-l528, CMS-l6l6, and

CMS-2599), the workload must exclude the number of replicate claims

produced.