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Duplicate Claims

Definition

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 you 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 which lengthens the claim processing time.
  • If you resubmit a claim, we will ultimately deny the claim as a duplicate.
  • The member will receive multiple EOBs for the same service, often resulting in a call to your office and/or ours.
  • The majority of claims submitted to BCBSTX are processed before 30 days.
  • In fact, most electronically submitted claims are processed within 14 days.

Prompt Pay Legislation Reminder

Per Senate Bill 418, a duplicate claim may not be submitted prior to the applicable 30-day (electronic) or 45-day (paper) claims payment period. In addition, you are required to indicate on the claim form, if you are submitting a duplicate claim. For physician or non-institutional providers, a D’ is required in field 10d on a CMS 1500 claim form or electronic equivalent. For institutional providers, the type of bill code requires a ‘7’ in the third position in field 4 on a UB-04 claim form or electronic equivalent.

Medicare Primary Claims

  • If we are secondary to Medicare, you should not send either a paper or electronic claim directly to BCBSTX. In most cases, the claim is automatically submitted to us by the Medicare Crossover vendor.
  • Professional providers may verify that the claim was forwarded through Crossover by checking the Medicare B Remittance Advice (RA). A message will appear on the RA confirming that the claim was forwarded electronically through Crossover.
  • Facility providers should check their electronic RA for confirmation that the claim was forwarded to BCBSTX through Crossover.
  • If you have not received notification that the claim was processed within 30 days, you may contact our office to verify receipt and/or processing of the claim.
  • If for some reason the RA does not indicate the claim was forwarded, you may then submit an electronic claim to BCBSTX including Medicare’s payment information, or a paper claim with a copy of the Medicare RA attached.

Before Submitting a Duplicate Claim

The next time you do not receive a response from your original claim, please take the following steps prior to submitting a duplicate claim:

If the original claim was submitted as paper:

Wait 30 days from the date you submitted the claim, before contacting Customer Service to verify receipt and next steps.

If the original claim was submitted as electronic:

  1. Access your response report, if you transmit claims through Availity to verify claims were accepted.
  2. Access our electronic database, NDAS Online.

NDAS Online – Free Internet Inquiry

NDAS Online is a free Internet inquiry solution allowing providers and submitters to utilize the Internet for immediate access to BCBSTX and HMO Blue Texas membership, eligibility, and BCBSTX claims status information from a secure Web site. Today NDAS Online allows access to BCBSTX and HMO eligibility with the ability to search by name or social security number. Claims status is available for BCBSTX. Future additions to the site will include benefits, deductibles, and HMO claim status, as well as other informational data. To sign up for NDAS Online, visit the NDAS Online Enrollment Application or email NDAS_Authorization@bcbsil.com for all application inquiries.