• Same Claim or service submitted to the insurance company twice, but the medical service performed only once.

Suppose whenever Provider or Billing team submits the same claim or service more than once to the insurance company.  In this case Insurance Company will process the original claim by denying the other claims as CO 18 Duplicate claim or Service.

Solution:

As we stated insurance company will adjudicate the original claim and deny the other subsequent claims as CO 18 Duplicate claim or Service. So we need to first check with the insurance company, whether the original claim processed towards payment or it’s denied and take a further action accordingly.

• If same service performed by another provider on the same day and it’s been already processed prior to your claim.

Let us understand this scenario, suppose when patient receives the same treatment or service on the same day with two different providers.  And if the other provider received a payment prior to your claim from the insurance company for the services rendered, then in that case insurance company may deny your claim as CO 18 Duplicate claim or service.

Solution:

In this type of scenario we will come to know only when we contact the customer service department.  So when you come across this type of scenario, explain the representative of the claims department as same service performed on the same day by two different providers and send the claim back for reprocessing. If they disagree to send the claim back for reprocessing, then you have rights to appeal the claim with supporting documentation.

• If same service performed more than once by same provider.

Service or procedure performed more than once by the same provider on the same day and the claims submitted without indicating a modifier.

In this case insurance company will process the first claim and the second claim will be denied as CO 18 Duplicate Claim or service.

Solution:

We need to append the second claim with an appropriate modifier (Modifier 76) or check with coder and resubmit the claim as corrected claim. If it is already submitted with appropriate and still it’s denied for the same reason, then you have rights to appeal the claim with supporting documentation.

• If same service performed bilaterally by same provider and claims submitted without a modifier.

Let us see with Example:

Suppose same service performed for both the hand by the same provider and claim submitted without indicating a modifier. In this case insurance company will pay for one claim and other gets denied as CO 18 Duplicate claim or service.

Solution:

We need to append the appropriate Modifier 50 or RT and LT (Check with Coding team for an appropriate modifier), which indicates same procedure performed bilaterally.

• If claim has been corrected but it’s been resubmitted without indicating as corrected claim.

Suppose corrected claim resubmitted without indicating as corrected claim, then the claim gets denied as CO 18 Duplicate Claim or Service.

Solution:

Whenever claim has been corrected, we have to make sure to indicate the claim as corrected claim along with Claim# on the claim form in order process the corrected claim appropriately.

As you can see there are many reasons why claim gets denied as Duplicate service, so we should do little research and take an appropriate action to resolve the issue.

Or

You can call the insurance company claims department directly and check why your claim is duplicating with the following questions.