Reworked claim submission - payer reports duplicate

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rprasadb2000
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Reworked claim submission - payer reports duplicate

Post by rprasadb2000 » Fri Feb 17, 2017 4:27 am

Hi,

We have many denials and we are working on those. When we resubmit the claims using Revenue management, payer reports duplicate service entry.

Do we need to delete the existing claim and file a new claim or something is to be added in EDI notes?

Thanks
Rajendra Prasad

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Gavin Walker
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Re: Reworked claim submission - payer reports duplicate

Post by Gavin Walker » Fri Feb 17, 2017 2:23 pm

That simply means that the payer has received the claim twice. You should have received the real eob from the payer from the first claim that you submitted. If you do not have it, then you'll need to request the eob again from the payer or maybe your clearinghouse can reload it again if it was electronic.
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rprasadb2000
Posts: 13
Joined: Mon Dec 19, 2016 4:23 am

Re: Reworked claim submission - payer reports duplicate

Post by rprasadb2000 » Sat Feb 18, 2017 8:52 am

We have received first claim EOB and payment was denied. That is the reason we are correcting the claim and resubmitting it. On subsequent submit using Revenue Management, it is declared as duplicate. How do we tell the payer that this is reworked claim using revenue management.

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Gavin Walker
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Re: Reworked claim submission - payer reports duplicate

Post by Gavin Walker » Sat Feb 18, 2017 1:01 pm

In Claim Management, edit the claim and set the Frequency Type to 7. Then on the Case go to the Medicaid and Tricare tab and enter the Resubmission Number and/or Original Reference Number if applicable.

rprasadb2000
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Re: Reworked claim submission - payer reports duplicate

Post by rprasadb2000 » Mon Feb 20, 2017 1:00 pm

Thanks for the info and that help us a lot.

Can we use the same procedure for partially paid claim as well? I mean, if some of the service line is paid and some are denied, can we use the same procedure?

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Gavin Walker
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Re: Reworked claim submission - payer reports duplicate

Post by Gavin Walker » Mon Feb 20, 2017 2:08 pm

Yes you can but you will need to resend the entire claim and not just the line items that were denied.The payer will likely take back the payment they initially gave you and then send a payment based on the new claim.

kidspeds
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Re: Reworked claim submission - payer reports duplicate

Post by kidspeds » Tue Nov 28, 2017 12:12 pm

we have the same problem, but there is no EOB it just says Duplicate claims from the clearing house, call the clearing house ?
Also one of the vaccines requiring 2 NDC codes (pentacel) how do we enter it ?
Thanks
Usha

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Gavin Walker
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Re: Reworked claim submission - payer reports duplicate

Post by Gavin Walker » Thu Nov 30, 2017 9:30 am

What did you have entered for the Claim Frequency Type?

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