Reminders on How to Prevent Duplicate Claim Submissions

NGS is in the process of identifying providers in Jurisdiction 13 (Connecticut and New York) who continually submit multiple duplicate claims. Providers who have a high amount of duplicate claim submissions to National Government Services will be contacted in the next few weeks. These providers will be asked to explain the reason(s) for the duplicative billing and education will be provided to avoid excessive submissions in the future.

The definition of a duplicate claim submission is when a provider resubmits a claim either on paper or electronically for a single encounter and the service is provided by the same provider to the:

• same beneficiary; for the
• same item(s) or service(s); for the
• same date(s) of service.

You can identify claims that are denied as a duplicate submission by reviewing your remittance advice (RA). Your RA will provide you with the American National Standard Institute (ANSI) group code “CO” and reason code “18.” A complete listing of ANSI group codes can be accessed at www.wpc-edi.com.

If more than one claim is submitted for the same item for the same date of service, the second claim will be denied as duplicate. This can occur even if the original claim is in a processing status waiting to be paid.