Eliminate Duplicate Claim Submissions and Denials

Noridian conducts data analysis to detect trends and topics for supplier education. Currently, we are analyzing duplicate claim submission patterns in Jurisdiction A (JA).

Although individual suppliers will be contacted, as needed, all suppliers are encouraged to review the CMS Medicare Learning Network (MLN) Matters Special Edition (SE)0415 - Reminder to Stop Duplicate Billings.

  • Some providers routinely submit duplicate claims for a single service encounter. This is inappropriate. CMS asks providers and suppliers to discontinue this practice. Unlike other health insurance payers, where it is customary to bill until paid, multiple or repetitive billing to Medicare for a particular item or service is improper.
  • When submitting more than one claim for the same item or service, expect the duplicate claims to be denied. Duplicate claims: 1) may delay payment; 2) could cause you to be identified as an abusive biller; or 3) if a pattern of duplicate billing is identified, may generate an investigation for fraud.
  • Medicare does not make payment for duplicate claims that may be submitted. CMS will pay the first approved claim but will deny subsequent claims for the same service as duplicates. Although Medicare is prohibited by law from paying claims immediately, over 90% of clean, payable claims are paid within 30 days.
  • Once a claim is submitted, do not continue to re-submit until reimbursement is made. One submission is all that is required.

Please refrain from submitting multiple claims to Medicare for the same item or service. Be sure your billing staff or third-party billing service understands Medicare claims filing rules.

If you have not received payment after 30 days and are concerned, use our self-service tools (Noridian Medicare Portal (NMP) and/or the Interactive Voice Response (IVR)) to research the claim(s). Visit the NMP and/or the IVR webpage for details about each. For more complex inquiries, which cannot be answered through the NMP or the IVR, contact the Supplier Contact Center.

In addition to the above, our website also contains valuable resources and tools (e.g. calculators and decision trees) to assist suppliers in correctly billing a claim the first time.

Noridian appreciates your cooperation in avoiding duplicate billing. Doing so will help Medicare process all claims more efficiently and cost-effectively so that timely payments can continue to be made.

 

Last Updated Mar 28, 2019