Institutional Claims Denying as Duplicate in Error, TR 29541

February 26, 2013

Institutional Claims Denying as Duplicate in Error, TR 29541 Some institutional claims are denying as a duplicate in error. We are working to resolve this issue and will notify you when it has been corrected.

Here are examples of when institutional claims may deny as a duplicate in error:

• Claims where a member is admitted and discharged from a facility, then readmitted to the same or another facility on the same day are denying as duplicate. This is happening because the discharge date on one claim is the same as the admit date on the second claim.

• Critical Access Hospitals are required to submit two claims when their emergency room claims become an admission. Because the emergency room claim and the admission claim have the same date, it is causing duplicate denials in error.

• RHC/FQHC claims are currently denying as duplicates when members are seen for mental health and medical services on the same day, by the same provider.

You can identify these claims denying as duplicates in error on your Remittance Advice (RA) by reason code:

• Claims Adjustment Reason Code (CARC) 18- “Duplicate claim/service.”