Published 04/02/2021

Narrative: Exact duplicate claim/service. (Use only with Group Code OA [other adjustments] except where state workers' compensation regulations requires CO [contractual obligation].)


Narrative: Duplicate of a claim processed, or to be processed, as a crossover claim.

Reason for Non-Coverage
A procedure with the same date of service has already been submitted and:

  • Paid on another claim, or
  • Submitted and payment is pending on a separate claim, or
  • Submitted and is awaiting crossover to the Benefits Coordination & Recovery Center on a separate claim, or
  • Submitted and is an office visit performed by the same specialty in the same group

Claim Denial vs. Rejection: Denial

Appeal Rights: Yes

Patient Responsibility: OA – Other Adjustments

Reference and Educational Material: CMS IOM Publication 100-04, Chapter 1 (PDF, 1.62 MB), Section 120.

Utilize the Palmetto GBA eServices Portal or IVR to verify claim adjudication status of the initial claim submission before submitting another claim.

Consider submitting all services rendered on the same date of service with a single claim submission to reduce the potential for duplicate claim denials that could result from multiple claim submissions for services performed on the same date of service.

What to include in the appeal?
Documentation supporting the service(s) was not a duplicate. The documentation must be submitted for each service billed (including those paid).

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