Denial Code CO 18

Insurance companies may use denial code CO 18 – Duplicate Claim/Service to indicate that a claim or service has been rejected because it is considered a duplicate of an original claim or service that has already been adjudicated. This denial code is typically applied when the insurance company has already processed and paid out for the same service or claim, and thus considers the new submission redundant.

Insurance companies implement strict procedures and coding systems to identify and prevent duplicate claims to ensure integrity in the claims processing and payment process. Timely identification and rejection of duplicate claims help prevent unnecessary costs and fraud within the insurance system.

Claim or service can be denied with denial code 18 for the following reasons:

• Claim or service denial with denial code 18 occurs when a healthcare provider submits a claim to an insurance company for a medical service that was rendered only once, but the claim itself includes billing for the service more than once. This can lead to the insurance company rejecting the claim and issuing denial code 18 based on the discrepancy between the billed quantity of the service and the actual number of times it was provided.
• Denial code CO 18 can be triggered when a claim or service is denied due to the patient receiving the same service on the same day from two different providers, and the insurance has already processed the claim from the other provider prior to the one being denied. This scenario typically occurs when there is duplication of services billed by multiple providers for the same episode of care within a single day.
• Same service was performed twice by the same provider on the same day.
• When a provider performs the same service bilaterally but fails to indicate this with the appropriate modifier on the claim.
• When a corrected claim is resubmitted without indicating it as such.

Denial Code CO 18 resolutions:

When provider renders medical service once, but the claim or service billed more than once to the insurance company:

When a medical provider mistakenly bills a claim or service more than once to an insurance company, the insurance company will typically adjudicate the original claim and deny the duplicate one with denial code CO 18. To resolve this situation, it is crucial to first determine the status of the original claim. If the original claim was denied, it is essential to analyze the specific denial code received and take appropriate action accordingly.

On the same day, if patient receives the same service by two different providers and insurance already processed another provider claim prior to your claim:

In the scenario where a patient receives the same medical treatment on the same day from two different medical doctors and one doctor’s claim has been adjudicated and paid prior to the other claim, resulting in a denial of the latter claim with denial code CO 18, there are specific steps that can be taken to address this issue.

The resolution to this situation involves first reaching out to the claims department and requesting a representative to send the claim back for reprocessing, highlighting that the same service was performed by two different providers on the same day. If the representative disagrees with this course of action, it is important to then proceed with appealing the claim, providing supporting documents to substantiate the legitimacy of the claim.

On the same day, same service performed twice by the same provider:

Modifiers are essential elements in medical billing that help to indicate specific circumstances surrounding a service provided by healthcare providers. In the mentioned scenario, the role of modifiers is highlighted as a critical component in ensuring accurate claim adjudication by insurance companies. When the same service is performed by the same provider multiple times on the same day without indicating a modifier, it can lead to claim denials with denial code CO 18.

The resolution for this issue involves appending the appropriate modifier, such as modifier 76, or consulting with the coding team to determine the correct modifier for the situation. It is crucial to submit the corrected claim with the necessary modifier to ensure that both claims are processed accurately and in compliance with insurance guidelines. When a claim is submitted with the appropriate modifier but is still denied, it is crucial to understand the reason for denial in order to effectively appeal the decision.

If provider performs same service bilaterally, but claim submitted without indicating an appropriate modifier:

When a healthcare provider performs the same treatment on both legs on the same day and submits a claim without indicating a modifier LT and RT or 50 for the line items, insurance companies may process one claim while denying the others with denial code CO 18.

To resolve this issue, it is essential to review the medical records and append the appropriate modifiers RT and LT or 50.

When corrected claim resubmitted without indicating it as corrected claim:

It is crucial to clearly label corrected claims as “Corrected claim” to ensure proper processing by insurance companies. Failure to do so may result in denial of the claim with denial code CO 18. By indicating that a claim has been corrected, insurance companies can prioritize these cases and accurately review the adjustments made.

Medical Billing Denials and actions – Top Denial codes Solutions (medicalbillingcycle.com)