What is a Duplicate claim (CO18 denial code)?
In simple terms, The CO18 denial code is a Duplicate claim defined as Claims submitted are exact duplicates of previous claims submitted. In general, insurance will never pay the claim that paid before. If submitting the same claim that was already paid or already processed then that is duplication. Duplication denial has many scenarios and each varies from one another.
Types of Claim duplication (CO18 denial code)
- Submitting a claim with the same billed amount, the charge was already paid to the same provider.
- Submitting the same claim serviced on the same date of service for the same patient.
- Instead of a corrected claim submitting a new claim can be denied as a duplicate claim.
How to validate the duplication denial
- Need to validate the Cpt billed with the duplicate claim and original claim. if it is different then it is not duplicate
- Check for the diagnosis code if it differs in both claims then it is not duplicate.
- Check for the Date of service in both claim forms if differs ask the rep to reprocess the claim.
- Validate the Servicing provider if, both claims have different providers then it is not duplicate.
Now let us see how to solve the denial for CO 18 denial. Below you can see the flow chart where you can get all the necessary questions to probe with the representative.
Questions for CO18 denial code (Claim duplication)
In short, Duplication has important end action as discussed one is to Correct/appeal the claim if the claim is actual duplication of the original claim. if it is not a duplicate claim ask the rep to reprocess the claim for payment. in some cases, the rep wouldn’t send the claim back for reprocessing. In that case, you can probe using the parameters mentioned in the chart.
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