Exact Duplicate Claim/Service - JE Part B

Common Reason for Message

• This is a duplicate to a service that has already been paid.

Next Steps

• Verify medical documentation for the following:
  • Service appropriate to bill
  • Date of service
  • Is a modifier required?
  • Payment already allowed and/or paid to patient's deductible
• Submit 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 most appropriate repeat modifier to procedure code
  • Modifier 76 - Repeat procedure by same physician
  • Modifier 91 - Repeat clinical diagnostic lab test
  • Modifier JW - Drug amount discarded/not administered to any patient
• When possible include all line items on a single claim
• Allow 30 days from first claim submission before resubmitting or after remittance received
• Check claim status via Noridian Medicare Portal or the Interactive Voice Response (IVR)