If you submit more than one Medicare claim to Texas' Medicare Administrative Contractor (MAC), TrailBlazer Health Enterprises, for the same item or service, expect your duplicate claim(s) to be denied.
Apparently, some physicians routinely submit duplicate claims - sometimes multiple times - to TrailBlazer for a single service encounter. In addition to delaying payment, this habit could flag you as an abusive biller. A pattern of duplicate billing could generate an investigation of your practice for fraud.
Once you've submitted a claim, you should not resubmit it until the claim is processed.
- If you have not received payment for a submission after 30 days and are concerned about the delay - don't resubmit. Contact TrailBlazer's toll-free Part B Interactive Voice Response (IVR) line for Texas at (877) 567-9230 to find out the status of your claim. The Part B IVR line can provide this information the day after you submit your claim electronically.
- If the reason for nonpayment is in question, call the Texas Provider Inquiries line at (866) 280-6520 to verify claims processing information. Don't refile the claim until you know a new claim is necessary.
When a claim (or claims) you've submitted is denied as duplicate, the Part B IVR will give the status of the most recently processed claim for that service first, i.e., for the denied duplicate claim(s). You should keep entering the date of service until you hear the message "We have no claims for this date." Then you will be able to receive claim payment information for the original claim or the reason why it continues to be denied.
Remember, duplicate billing is costly to you and the Medicare program. Only one submission is required.
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Last Updated On
May 17, 2016
Originally Published On
March 23, 2010