Claim denials and reimbursement delays can keep any healthcare provider up at night. It is not a secret that these problems compromise the quality of the services and hinder the financial growth of a practice.
Among various billing errors, duplicate claims are the most frequent problem. Insurance companies use the CO 18 denial code to specify this error. You should avoid duplicate claims at all costs since they not only result in payment delays but also impact the reputation of your service.
However, even medical billing professionals can make mistakes. So, read our guide if a payer has recently denied your claim with a denial code CO 18.
CO 18 Denial Code – Description
Insurance companies use the CO 18 denial code to highlight a duplicate claim. In simple words, this code indicates that the healthcare provider has resubmitted a previously reimbursed claim or service. But what exactly is a duplicate claim?
Insurance companies flag a medical claim as a duplicate based on:
- CPT codes
- Type, place, and date of service
- Provider number
- Billed amount
To clear up any confusion, let’s consider a real-world example.
A patient receives physiotherapy for acute pain from two therapists at the same hospital and on the same day. Due to a lack of coordination, both therapists submit medical claims. Since the service type, date, and place overlap in both medical claims, the insurance company denies the second claim with a CO 18 denial code.
The major problem is that CO 18 is one of the most common denials in medical billing, and you simply cannot afford to ignore it. However, you can avoid this claim denial by understanding the main reasons behind it.
Common Causes of CO 18 Denial Code
Claim denials are a persistent problem for healthcare organizations. Many professionals are forced to spend hundreds of dollars to receive their rightful reimbursements. According to a healthcare company, Premier, providers spend an average of $43.84 per claim to overturn the denials.
Although this amount may seem insignificant, the total annual cost of rework due to claim rejections adds up to $19.7 billion. You can only avoid these denials by understanding the root cause of the problem.
Are you tired of frequently seeing the CO 18 denial code on your submitted claims? You might be receiving it for the following reasons.
Duplicate Claim Submission
Healthcare providers mainly receive the CO 18 denial code due to duplicate submissions. It means that insurance companies deny reimbursements for claims or services submitted multiple times. This common mistake can happen to anyone due to poor communication and software issues.
Billing Errors
CO 18 denial codes occur due to duplicate medical claims, so why do healthcare providers submit the same claim multiple times? They don’t do it on purpose! Billing errors, such as incorrect coding or patient information, are the main reason behind duplicate claims.
Poor Coordination & Communication
Poor communication and coordination also result in duplicate claims, especially if multiple healthcare providers offer services to the same patient. More often than not, different departments submit the same claim more than once. As a result, payers deny the duplicate claims with the CO 18 denial code.
Mistakes in Resubmission
Insurance companies also sometimes flag the resubmitted claims as duplicates. It happens when healthcare providers resubmit medical claims without proper corrections.
Glitches in System & Software
Technical issues are also one of the reasons for duplicate claims. Software glitches, system errors, and device incompatibility may lead to insurance companies receiving the same claim multiple times.
Preventive Strategies for Denial Code CO 18
CO 18 is one of the costlier denial codes. It not only impacts the quality of your services but also your reputation. You can avoid this code by implementing the following.
Review Claims Before Submission
Establish a proper billing process. Assign staff to thoroughly review the medical claims before submitting them to the insurance company. Check everything and confirm that there aren’t any duplicate services to avoid the CO 18 denial code.
Proper Documentation
You can also avoid the CO 18 denial code through proper documentation. Record everything, from the patient’s information and the date of the services to the necessary changes during the procedure. This documentation will help you identify duplicate claims.
Improve Coordination & Communication
Encourage coordination and effective communication between different departments. Make sure everyone involved in the revenue cycle management process is on the same page, including healthcare providers and the medical billing team.
CO 18 Denial Code – Management & Resolution
According to the Healthcare Financial Management Association (HFMA), two-thirds of preventable denial codes can be overturned successfully.
So, don’t worry if you have received a CO 18 denial code. Simply take the following steps to address this code.
Check the Denied Claim
Carefully check the medical claim to see if it is a copy of the previously submitted one. Review all the details in the Explanation of Benefits (EOB) document to understand why the insurance company has classified your claim as a duplicate.
Review Your Documentation
Retrieve all the relevant documents and compare details to see if you actually submitted the claim more than once. If it is indeed a duplicate, identify the reason for this mistake.
Correct & Resubmit the Claim
Make the required corrections in case of common mistake or any other error and resubmit the medical claim. Thoroughly review the medical claim before resubmission to avoid claim denial.
Appeal if Necessary
If the insurance company has mistakenly marked your claim as a duplicate, appeal with the relevant documents. Contact the payer to clarify the issue and follow their guidelines to reverse the denial.
Outsource Denial Management to Professional Service Providers
If you don’t want to spend your valuable time resolving CO 18 denials, get in touch with a denial management specialist. Read online reviews and choose one of the most reliable denial management service providers to manage your rejected claims. These experts will help you receive your compensation on time.
Bottom Line
Your billing process is not efficient if you constantly receive CO 18 denial codes. You can only improve the accuracy of your billing process by addressing the main reasons behind this denial code.
We have provided a detailed guide on this denial code so you can receive timely compensation for your services and focus on more important things – improving the patients’ health.
