CO18 denial code description and corrective action

• This denial mostly occurs when we bill same service/claim of the same date of service more than one time.

• Sometime we bill the claim twice in error then we receive this denial. In this case the first one processed while the other one denied as duplicate of the first one.

Actions

• First, we need to verify the status of the claim. This can be done by checking the status through the insurance web portal or by calling the payer.

• The first and most important step is to determine whether the claim denial is valid or if the insurance has denied the claim by mistake.

• Call the insurance company, and if the claim was billed twice by mistake, obtain the status of the original claim and proceed accordingly.

  Sometimes the procedure is the same but has a different modifier, provider, or visit time. In such cases, we discuss this with the representative and request reprocessing of the claim. Be sure to note the claim number, the representative’s name, and the call reference number, and then follow up on the claim after the provided TAT.

  If the patient visited twice on the same day but we did not append a modifier to indicate the second visit, the representative will deny reprocessing. In this case, we need to submit a corrected claim with the required modification (modifier).

• If the patient visited twice, the coding is correct, and the representative does not agree to reprocess the claim, then we proceed with submitting an appeal along with the necessary supporting documents to justify the services.

• For submitting an appeal, we must calculate the timely filing limit starting from the processed date. If the limit has been exceeded, the claim will be denied again for exceeding the filing deadline. In such cases, we should consult with the provider. Some clients may still want us to submit the appeal even after the timely filing limit has passed, so we should proceed according to their instructions.

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