Duplicate Claim Submission:
Any claim submitted by a physician or provider for the same service provided to a particular individual on a specified date of service that was included in a previously submitted claim. This does not include corrected claims.
Facts About Resubmitting Claims
Before you resubmit a claim because we have not received your payment or a response regarding your payment, stop and think. By sending another claim, you are adversely affecting the claims payment process and potentially creating confusion for the member.
- By resubmitting your service(s) a second time, we must conduct additional investigative steps that lengthen the claim processing time.
- If you resubmit a claim, we will ultimately deny the claim as a duplicate.
- The member will receive multiple EOB’s for the same service, often resulting in a call to your office and/or ours.
- The majority of claims are processed before 30 days.
- In fact, most electronically submitted claims are processed within 14 days.
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