Duplicate Claim Reminders

Duplicate claims are one of Noridian’s top denials. A resubmitted claim that appears the same as the original claim will deny as Medicare contractors cannot override or bypass exact duplicate edits in the claims processing system. In order to reduce the number of duplicate denials in your practice, please review the suggestions below.

Make sure that your practice is:

  • Waiting for remittance advice before correcting claim via rebilling or appealing
  • Talking to the clearinghouse or vendor to only auto-rebill after 30 days
  • Using repeat modifiers (76, 77 or 91) when repeating procedures or labs
  • Utilizing the Noridian Medicare Portal (NMP) to check claim status

Avoid the following:

  • Resubmitting claims unless rejected unprocessable
  • Adding or deleting procedure or diagnosis codes
  • Splitting claims for resubmission
  • Resubmitting entire claim when partial payment made
  • Appending modifier 59 unless it meets National Correct Coding Initiative (NCCI) Edits
    • With indicator 1

Resources:

 

            Last Updated Fri, 29 Jan 2021 21:29:38 +0000