Duplicate Claims Filing Is Costly

You never should routinely file a paper claim as an exact duplicate of an electronic claim without giving the health plan enough time to process the electronic claim. This second (tracer) claim creates additional investigation for both claims, which lengthens the claim processing time and ultimately delays payment.

Instead, you should carefully review your electronic claim response reports to ensure that all of your electronic claims were accepted into the payers' systems. Correct rejected claims and resubmit them electronically.

Remember:

 

  • Resubmission of claims accepted into the system will cause the new claim to be rejected as a duplicate and delay the entire adjudication process.
  • If there was an error on the original electronic claim, chances are you'll refile the tracer with the same error, with the same result - claim rejection.
  • For every claim the health plan handles twice, your office staff also is  processing a multiple claim. This means increased administrative expenses for your office, such as staff time, paper, and postage costs. 
  • For plans that are regulated by the Texas Department of Insurance, Prompt Pay rules prohibit physicians and providers from filing duplicate claims before Day 46. 

 

Content reviewed: 7/24/2008

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