Duplicate Claim Edit for Referred Lab Services

Effective April 01, 2005, a new edit will be established in Medicare systems to check for duplicate claims for referred clinical diagnostic laboratory services and purchased diagnostic services submitted by physicians/suppliers to more than one carrier.

Claims submitted for referred clinical diagnostic/purchased diagnostic services will be identified as “duplicate claims” when the involved claims contain different carrier numbers and all of the following data matches in the claim fields:

• Beneficiary Name
• Beneficiary Health Insurance Claim Number (HICN)
• Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) code
• Date of Service
• CPT/HCPCS Code Modifier