AZ BCBS Implementing New Duplicate Denial Reasons

www.azblue.com

I received an email today from BCBS... Good to know info ;-)

Please visit their website or call them if you have any questions or concerns regarding the information listed below.


NEW DUPLICATE CLAIM DENIAL REASONS

BCBSAZ has recently implemented new and more informative duplicate denial reasons. Our hope is that the new denial reasons will provide a better explanation as to why your claim was considered a duplicate and will assist you in determining what action may need to be taken. Please see the attachment for a sample of the new duplicate denial reason code narratives.

When researching a claim that has denied as being a duplicate, please log into “BlueNet” and access the Online Remit link found on the provider portal under the Claims Management tab. Only the online remittance will provide you with the new specific reasons as to why BCBSAZ considered the claim to be a duplicate. The electronic remittance advice (ERA) will only display the ANSI standard duplicate reason code.

After your review, determine what steps may be needed using the instructions outlined below:

• If the original claim information was wrong or in-complete, submit a corrected claim or an E-adjustment. Do not send a new claim.
• Or; if you’ve confirmed the claim was in fact not a duplicate and you believe NO change or correction is required, follow the process for filing a formal grievance.

The process for corrected claims and grievances apply to a single claim for a specific member. However, if you have more than 10 claim corrections and grievances for the same situation please contact your network contract specialist.

BCBSAZ requests that corrected claims and grievances be submitted electronically via the BlueNet provider portal. From the secure provider portal homepage, click on the Claims Management tab. Next, click on the Claim Status link to perform a claim status look up. Select the appropriate claim that you determine needs to be corrected or grieved and then click on either the Claim Action request Form to file a corrected claim or the Appeal Form to submit a grievance.

If you are unable to submit corrected claims or grievances electronically submit a completed Corrected Claim Form or Provider Grievance Form. From the azblue.com “Providers” tab on the public home page on the right side, look under the category Quick Links and select Forms & Resources to be directed to the online forms. The online Corrected Claim and Grievance forms can also be found in the secured provider portal as well as in the Provider Operating Guide.

We encourage providers to file corrected claims and grievances electronically since there are many benefits to filing electronically:

• Reduces paper handling and simplifies the process
• Expedites your request
• Allows provider to attach documentation necessary to support your request
• Allows providers to track Claims Corrections and Grievances submitted via the online Confirmation page

For more details on the types of transactions that can be filed electronically refer to “Doing Business Electronically” and the “Electronic Adjustment User Guide”.

examples of New Duplicate denial Reason codes	Provider Action
BCBSAZ denied this claim because the remarks submitted with the claim show it as a correction to a previously filed claim. It needs to be submitted as an adjustment. Please resubmit this claim using the claim frequency code 7 or 8. Refer to the corrected claim form to see if medical records are also needed.	The duplicate claim was submitted indicating a correction was needed. After reviewing the claim, if a correction is needed providers need to submit a corrected claim or an e-adjustment using the claim frequency code 7 or 8.
BCBSAZdenied payment for this claim as a possible duplicate. BCBSAZ has already processed a claim for this same member, provider, service and date. If the patient was seen more than once in the same emergency room on the same date, the claim should be billed with condition code g0 or modifier 27.	After reviewing the claim it is determined that the patient was seen more than once in the emergency room on the same date, the claim that was denied for being a duplicate should be submitted as a corrected claim adding condition code g0 or modifier 27
BCBSAZ denied payment for this claim as a possible duplicate of a previously processed claim for the same date, provider, and service. Although the prior claim has a different diagnosis, to change the claim, you must submit a corrected claim with medical records, supporting documentation and the reason for the change or correction. BCBSAZ can take no further action on this claim until this information is submitted.	After reviewing the claim if the prior processed claim should have had a different diagnosis submit a corrected claim or e-adjustment. If you’ve confirmed the claim was not a duplicate and no change or correction is required, follow the process for filing a formal grievance. Medical records and/or, supporting documentation must be submitted in both instances.
BCBSAZ has denied this claim as a duplicate of a prior claim for which BCBSAZ requested medical records. BCBSAZ has not received the requested records, and cannot process any claims for these services without those records. Please submit the requested records.	Providers should not submit a new claim. Submit only the medical records requested attached to the letter we sent you requesting the information needed. Please read the record request letter from us carefully and include all items requested.
This is a duplicate of a previously submitted claim for which BCBSAZ requested medical records. We will use the submitted records to complete processing of the initial claim. For record keeping purposes, we must deny this claim as a duplicate, but it will not affect the processing of the initial claim.	Providers should not submit a new claim. The initial claim will be reviewed and determination will be provided after medical review is completed