Noridian Duplicate Denials

Each month Noridian receives several thousand duplicate claims. When a duplicate claim is submitted, it will reject through Noridian’s Part B Noridian Custom Edits (NCE) with the follow message:

"Smart Edit DCP: This line is a possible duplicate of a claim performed by the same provider on the same day. If you feel you have received this message in error or if you need to resubmit the claim without making any changes, please resubmit your claim on the next business day."

If a duplicate claim continues to be submitted and passes through Noridian’s upfront edits, one of three possible denials will occur:

  1. Duplicate to another claim on the same date of service:
    • CO-97: The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF),
    • N111: No appeal right except duplicate claim/service issue. This service was included in a claim that has been previously billed and adjudicated,
  2. Exact duplicate to another claim on same date of service:
    • OA-18: Exact duplicate claim/service,
    • N522: Duplicate of a claim processed, or to be processed, as a crossover claim.
  3. Duplicate to another provider’s claim on the same DOS:
    • B20: Procedure/service was partially or fully furnished by another provider.

When a claim denies for duplicate, the Noridian Medicare Portal (NMP) will provide the duplicate claim information. When viewing the status of a claim on NMP, there will be a button on the right side of the screen that says, "related claim details". By clicking on that button, a provider can view the previously processed claim and provider information.

Resources

 

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