Reason Code: OA-18

Error Description:

Exact duplicate claim/service.

Avoiding/Correcting This Error

A duplicate claim submission occurs when a provider resubmits a claim either on paper or electronically for a single encounter and the service is provided by the same provider to the:

• same beneficiary; for the
• same item(s) or service(s); for the
• same date(s) of service.

If more than one claim is submitted for the same item for the same date of service, the second claim will be denied as duplicate. This can occur even if the original claim is in a processing status waiting to be paid. 

It is critical that you do not resubmit another claim until you know the status of your original submission. If you haven’t received your RA, and you submit claim(s) again, you may receive the duplicate claim denial before you receive the RA for the first submission detailing the payment or denial of services. 

Electronic Claim Submitter Tips:

• Check your EDI validation report to verify your claims were received and accepted or which claims may have rejected. If you are unsure how to check these reports, contact the EDI Help Desk at 877-273-4334.
• Do not set up your claims software system to automatically rebill Medicare claims.
  • Before resubmitting Medicare claims, verify the claim status by utilizing NGSConnex/IVR system.
• Ensure that your claims batching process is functioning properly.

Remittance Advice Tips:

• Pay close attention to your RA to determine if the denied claim(s) should be resubmitted or appealed.
• Make sure that your billing staff or third-party billing service knows the Medicare payment floor standards.