In Revenue Cycle Management, there are multiple reasons when insurance companies denied the claim. CO-18 is one of the primary denial reason and claims frequently denied due to this reason as duplicate claim. Denial Code CO18 meaning is exact duplicate claim, means claim is already paid or submitted twice by the insurer, provider or hospital.
Sometimes claims are just denied as duplicate but there is no matching in claims, in this we need to review the whole claim and history of claim for understand and clarify the situation.
How to handle denial CO-18 Duplicate Claim?
There are multiple scenarios to handle the CO18 denial code, so we have to check and review the exact reason of denial.
Case 1- Claim is denied as duplicate because patient already get paid for the same services earlier.
Solution – In this case we need to check patient history if ever paid for same service on same DOS (date of service), if DOS is different then need to send appeal with medical records.
Case – 2- Same service provided by different providers on different times.
Solution- Append modifier 77 and resubmit the claim.
Case -3- Same service same day same provider provided.
Solution- Append modifier 76 and resubmit the claim.
Case -4- Sometimes, it is not possible to find the exact information that why claim denied as duplicate, in this scenario we need to call insurance company and ask the information of original claim if any found like claim number, DOS, paid date, cheque number, cheque amount, cheque date, paid to facility etc.
CO-18 Duplicate denial is very common denial so need to aware some factors while submitting the claim first time to insurance company. List is mentioned below,
- Confirm primary and secondary payer before submission.
- Check coding part of the claim like modifiers and ICD codes.
- Ready necessary documents and medical reports if any confusion arise.
- Use correct modifiers like,
- Modifier 59: For distinct procedural services on the same day. Modifier 76: For repeat procedures by the same provider. Modifier 50, RT, LT: For bilateral procedures. Modifier 91: For repeat clinical diagnostic lab tests.
Note- Medicare denied claim duplicate with reason code OA-18.