Claim Rejected ( Duplicated claim )- ways to find outcome?
Q: My case dismisses, or was come back to supplier, as a copy of another case. Could I resubmit the case? What steps would I be able to take to keep away from copy claims?
A: Claim framework alters are set up to distinguish copy administrations. The alters seek inside paid, finished, pending, and same case subtle elements ever. This implies unless material modifiers and/or condition codes are incorporated into your case, the alters distinguish copy and rehash administrations inside the same case, and/or in view of a formerly submitted claim.
The accompanying reject reason codes are normally seen with this alter:
• 38005 - This case is a copy of a formerly submitted inpatient claim
• 38031 - This outpatient case is a conceivable copy to a formerly submitted outpatient claim
• 38035 - This outpatient case is a conceivable copy to a formerly submitted outpatient claim for the same supplier
• 38038 – This case is a conceivable copy of a formerly submitted claim
• 38200 - This is an accurate copy of a formerly submitted claim
The accompanying come back to supplier (RTP) reason codes are normally seen with this alter:
• 38032 - This outpatient case is a copy of a formerly prepared or submitted outpatient claim
• 38037 - This outpatient case is a copy of a formerly prepared or submitted outpatient claim
Your case rejected as a copy, since one or a greater amount of the accompanying things coordinated the first claim:
• Health Insurance Claim Number (HICN), supplier number, sort of bill (TOB)- - each of the three positions of any TOB, explanation scope from and through dates, no less than one finding or detail date of administration, income code, HCPCS code, and/or all out charges (0001 income line).
To counteract copy claims, confirm status of case before recording.
1. On the off chance that you utilize direct information section (DDE) pdf document, get to the recipient's HIC number to confirm the historical backdrop of cases submitted and the status/area of those cases. Note: you can't see claims presented by different offices.
2. Check status of cases by means of the Secure Provider Online Tool (SPOT).
3. Contact the intuitive voice reaction (IVR) pdf document framework by calling (877) 602-8816. There are three breakdowns accessible: claim status, come back to supplier and pending cases.
4. Audit the settlement guidance for the historical backdrop of the recipient's cases.
Furthermore, if your case incorporates rehash administrations or supplies, attach modifiers and/or condition codes, as appropriate. For a complete rundown of coding assets, allude to the Medicare Billing: 837I and Form CMS-1450 Fact Sheet outside pdf document
On the off chance that you submit claims by means of the electronic information exchange (EDI) door, you are given affirmation when the bunch of cases is gotten. Kindly sit tight for this affirmation, rather than resubmitting the group of cases. On the off chance that you roll out one improvement to one case in the bunch however resubmit the whole clump, all the cases go to the monetary mediator shared framework (FISS), bringing about copy claims. Try not to resubmit the whole cluster; resubmit redressed asserts as it were.
Note: If an outsider seller, charging administration, or clearinghouse submits claims for your sake, reach them to guarantee they are not resubmitting whole bunches of cases as portrayed previously. Likewise, infrequent programming glitches can bring about the resubmittal of a whole clump. Know that these product or seller issues reflect straightforwardly upon the supplier and are dangerous, best case scenario, and considered conceivable misuse, even under the least favorable conditions.
Recorded beneath are a few proposals, when extra activity is required to remedy your claim(s):
• You have two choices when the first handled claim should be overhauled or rectified.
1. Modify the first handled case (TOB xx7) and resubmit.
2. Scratch off the first handled case (TOB xx8) and present another case, however you should sit tight for the crossed out case to finish before the new claim is submitted.
• If two cases were submitted in the meantime and brought about copies against each other, present another case.
• If the rejected case is a careful copy to a formerly handled/finished case, no activity is essential.
