Duplicate Claim/Service - JE Part B
Duplicate Claim/Service
| CARC/RARC | Description |
|---|---|
| CO-97 | The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. |
| CO-B20 | Procedure/service was partially or fully furnished by another provider. |
| N111 | No appeal right except duplicate claim/service issue. This service was included in a claim that has been previously billed and adjudicated. |
Common Reason for Message
- This is a duplicate of a charge already submitted.
Next Step
- Verify documentation for the following:
- Service is appropriate to bill
- Is a modifier required?
- Payment was already allowed and/or paid to patient's deductible
- Submit an Appeal request - Items or services with this message have appeal rights
- Indicate services were not duplicate
- Submit documentation with Redetermination request. View Medical Documentation Requirements
Claim Submission Tips
- When billing repeat procedures, append repeat modifier to procedure code
- Most common repeat modifier
- Modifier 76 - Repeat procedure by same physician
- Modifier 77 - Repeat procedure by another physician
- Modifier 91 - Repeat clinical diagnostic lab test
- Most common repeat modifier
- Allow 30 days from first claim submission before resubmitting
- Check claim status via Interactive Voice Response (IVR) or the Noridian Medicare Portal
Last Updated Dec 09 , 2023
