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Issue Number - Name
0091 - Exact Duplicate Claims
Review Type
Automated
Claim Type
Professional Services (Physician/Non-Physician, Outpatient Hospital)
Region and State
RAC 1-4
All States
Date Approved
2018-05-08

Description

Duplicate claims are any claims paid across more than one claim number for the same beneficiary, CPT/HCPCS code and service state by the same provider.

Affected Code(s)

  • All CPT/HCPCS codes

Applicable Policy References

  • Title XVIII of the Social Security Act, Section 1833
  • CMS Pub. 100-06, Medicare Claims Processing Manual, Chapter 3, Section 10.2
  • CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, Chapter 20.4.2
  • CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 1, Section 120.2(B)
  • CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 26, Section 10.5