RCM Q&A 3 Duplicate Denial: Top RCM Technical Questions and Answers with Sample Notes

Question: How do you work on – Duplicate Denial

Answer :

Step1: The status of a claim can be found on the insurance company's website, Through EOB, Correspondence,.

Step2: Check-in the billing system, if you have any duplicate denial in the system. If yes check with the coding team. If it's a real duplicate adjust off the balance. If no

Step3: Call the insurance company and ask the rep May I know the claim received and denied date and the Original claim status

Step4: If the original claim is denied go by the denied scenario If it is paid go by the paid scenario and if it is in-process then go by the in-process scenario

Step5: May I know the original and current claim#, Could you please send the copy of EOB( duplicate copy)

Step 6: May I know the claim# and reference #

If you need to answer all the above-mentioned steps with the interviewer

Sample Notes : Claim # Dos mm/dd/yyyy @ t/t --- Sts Claim denied on mm/dd/yyyy as duplicate. Rep informed the claim was originally paid on mm/dd/yyyy for $ 00.00, chk#, it’s a bulk check for $00.00, cashed on mm/dd/yyyy or (not yet cashed). The pt has $00.00 as co-pay. The allowed amount is $00.00. Confirmed mailing address is correct. Req Eob (Do not req eob if it is less than 1 month.) Dup Clm#. Orig Clm#, Ref#.

Please forward this blog to any of your friends who are scheduled to attend an important interview.

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