![]() ![]() Sometimes claims can be resubmitted by simply correcting a diagnosis code, modifier, or other problem. ![]() If the first claim submitted was denied and the denial was handled correctly.If payment was sent to the patient for failure to check the ‘accept assignment’ box on the HCFA form?.If the check was deposited but missed in the posting process?.If the payment was made on the first claim, whether it was sent to the correct address?.For a claim that was submitted twice, a Find a Code article recommends verifying the following:.On the other hand, if you submitted the claim correctly and it was still denied, submit a letter of appeal with documentation for each specific service to prove it was performed more than once and therefore is not a duplicate service. If not, rebill it with the correct modifier. If the claim for a service performed more than once on the same day is denied, verify if you submitted the claim with the appropriate modifier and other requirements.How to Respond to Duplicate Service Denials Claims that are submitted without the necessary information will be returned or denied as duplicates. When a claim is corrected and resubmitted, it should be clearly indicated as a corrected claim along with the original claim ID, and reason for attachments or corrections. Submitting a corrected claim without proper information: It is important to file a corrected claim according to the payer’s specific instructions below to ensure that payer can identify the original claim, understand the correction that is required and ensure that the resubmitted claim is not denied as a duplicate.The practice’s medical billing service provider should ascertain whether the original claim has been processed for payment. The payer will reimburse only the original claim and deny the second one. This can occur inadvertently, but is a costly mistake. The service was performed once but billed twice: If the claim for a service is submitted twice, it will be denied as duplicate.Appending modifier 50 or RT and LT modifiers would indicate the same procedure performed bilaterally. Same service was performed bilaterally by one provider: Suppose the same provider performed the same procedure on both legs of the patient and both claims were submitted without the correct modifier, one claim may be paid and the other denied as a duplicate claim.If the claim is not reprocessed, it can be appealed with supporting documentation. In this case, the insurance company should be informed that provider B also performed the service and send the claim back for reprocessing. If provider A submitted a claim with the same CPT code as provider B and received a payment prior to provider B’s claim, then provider B’s claim will get denied. The same service was performed by another provider on the same date: A patient may receive a service on the same day with two different providers, A and B.If the claim is denied again, you can appeal and provide documentation. Modifier 76 is used for surgeries, x-rays and injections. Modifier 76 Repeat procedure or service by same physician or other qualified health care professional, should be appended to the second claim to indicate that the procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. The first claim is likely be processed and paid, and the second claim will be denied as a duplicate claim or service. The service was performed more than once on the same day: The same provider may provide the same service for the same patient multiple times on the same day.Reasons for Duplicate Claim/Service Denials ![]() Practices need to strictly adhere to claim submission rules to avoid duplicate claims, which are not only counterproductive and costly, but can lead to scrutiny and integrity actions by the Medicare administrative contractor (MAC). In most cases, the claim would have been already processed and paid or it is identical to a previously submitted claim. When a claim submitted by a medical coding company is denied as a duplicate service, it indicates that more than one claim was submitted for the same service, for the same patient, for the same date of service.īlue Cross Blue Shield defines a duplicate claim as: “Any claim submitted by a physician or provider for the same service provided to a particular individual on a specified date of service that was included in a previously submitted claim”. Every practice deals with claim denials and ‘duplicate service’ is a common reason for denial. ![]()
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