Denial Code CO18: Duplicate claim
Duplicate denials remain one of the most common billing errors. It can be both counter-productive and expensive to your procedure; it can get you in trouble. The Medicare administrative contractor may impose program honesty actions against your practice if you make too many mistakes. If any of the following aspects match, Medicare will instantly deny the claim: provider number, through the appointment, HIC number, procedure code, billed quantity, type of product or service, from date of service, and place of service. Any claim lines or claims with very intimately connected elements may also be evaluated. That means it’s critical to learn more about the co18 denial code, prevent it, and what to do if it occurs.
The most common reasons for denials
The following are the most common reasons why a claim may be denied and regarded as a duplicate claim:
- The same claim was filed twice.
- Resubmission of a revised claim.
- Another provider provided the same service on the same day.
- The same service is provided by the same provider numerous times.
- One provider provided the same service in both directions.
Denial code CO18 solutions
The same claim was submitted twice
When this happens, it’s usually just a significant error, but it can be costly. The insurance provider or Medicare will pay only one claim. The insurance company will decide on the initial claim and reject any successive claims. You should verify with the insurance company to see if the original claim was paid or denied.
Resubmission of corrected claim
If you refile a corrected claim without implying it has been fixed, you will receive a duplicate claim or service rejection. When a claim is updated, we must ensure that the claim is marked as a corrected claim, including the Claim# on the claim form, to effectively process the claim.
Another provider did the same service on the same date
Sometimes even a patient receives services from two different providers on the same day. Furthermore, if the other provider received the money before your claim, your claim will be denied. In this scenario, you must clarify that your provider also conducted the service and then resubmit the claim for processing. If they refuse to return the claim for reuse or recycling, you can file an appeal and provide relevant evidence.
The same service was done numerous times by the same provider
If the same service/procedure were conducted more than once on the same day and by the same supplier, the claim would be rejected if not uploaded with the appropriate modifier. The first claim will be filtered, while the second will be rejected as a duplicate claim or service. If this happens, add a suitable modifier to your second claim (Modifier 76). If it is denied again, you must appeal the decision and provide supporting documentation.
A single provider conducted the same service bilaterally
If the same provider conducted the same service on both of the patient’s legs and both claims were forwarded without the correct modifier, one claim may be paid, and the other rejected as a duplicate claim. To avoid this issue or resolve it if you already have one, you must bill with the appropriate modifier (Modifier 50 or RT and LT) to indicate that the procedure was conducted bilaterally.
Just because a claim for a duplicate claim or service was rejected does not imply it will never be compensated. There may be grounds to refile the claim or file an appeal against the denial in some instances. Always follow up on any rejection to figure out what’s wrong and see if there’s a way to solve it so you can get paid. Billing executive are the leading provider of medical billing services which can help you deal with these denials and recover your insurance coverage. Our accurate and cost-effective billing services will reduce billing and coding errors while increasing your practice’s collection. For more information, please get in touch with us at firstname.lastname@example.org
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