When determining whether or not a claim is a duplicate, Anthem BlueCross BlueShield cross-references the service and dateline to look for matches.
Although that’s the generally accepted definition, it may differ based on the insurance payer.Īnthem BlueCross BlueShield of Texas defines duplicate claims as.Īny 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 type of claim contains the same information as a previously submitted claim. The general definition of an exact duplicate claim is pretty straightforward. There are two main types of duplicate claims exact and suspect. If your doctor submits a claim, that will come back as CARC 18, "Exact duplicate claim/service". If an insurance company denies a claim, it will go back to your doctor as a Claim Adjustment Reason Codes (CARC) or Remittance Advice Remark Codes (RARC). There are thousands of variables these systems use to determine whether to accept or reject a claim. When your doctor submits the claim, it is their responsibility to record that the submission occurred. Once your doctor submits the claim, your insurance checks if it meets their criteria. To receive payment your doctor must follow that process.Įvery insurance company defines how they accept claims within their provider manual. To further complicate things, your healthcare insurance has a specific process for how they accept claims. Your doctor keeps track of everything performed, finds all their CPT codes and submits the claim.
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Each CPT code has its own dollar amount of value based on your health insurance. You can think of these codes as items on a receipt. The industry refers to these codes as Current Procedural Terminology (CPT) codes. Every test your doctor performed on you has a billing code.
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Once you get there, he performs a series of tests.
You have health insurance so you schedule and visit with your physician. Let's say you’re experiencing migraines that hamper your productivity at work. We will keep you informed throughout the process. We are committed to providing you with timely and accurate information on this situation.These claim mistakes happen when a healthcare organization.īills for the same patient procedure, treatment, or testing on more than one occasionīills for patient services that were never performed in the first placeĪttempts to bill Medicare, Medicaid, either another private insurance company or the patient right awayĬharges more than once for the same serviceĭoesn't check if they already billed for a procedure We offer our heartfelt thanks for your support, and pledge to continue to provide you with an exceptional patient experience each and every time. Or, you can contact Anthem customer service via the phone number on the back of your insurance card to verify and confirm the accuracy of your provider selection.Īs we move ahead, we look forward to the opportunity to serve you and your families in your health and wellness journey. Please take a moment and visit to review your member benefits and verify and confirm your choice of providers. What this means for you is that you can continue to seek care from the providers you know and trust.
Joseph Healthcare and all of the 225 affiliated providers will remain in the Anthem network through 2025. You’ve told us that you count on the relationships you’ve formed with your providers because of the exceptional care you’ve received.
Over the past months, many of you have reached out to tell us how much you value the care you’ve received at St. We are grateful for your patience and for the trust you’ve shown in us. On behalf of all of us at Covenant Health, and especially on behalf of our 225 providers affiliated with St. We know that there was uncertainty as the termination deadline loomed and this was unsettling. Earlier this week, we announced the successful completion of a new contract with Anthem Maine.
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