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Government Programs: Claims Rejecting as Duplicate Submissions

October 10, 2017

This notice applies to claims submitted by government programs providers for the following Blue Cross and Blue Shield of Texas (BCBSTX) members:

  • Blue Cross Medicare Advantage (PPO)SM (MA PPO)
  • Blue Cross Medicare Advantage (HMO)SM (MA HMO)
  • Medicaid STAR, STAR Kids and CHIP

Providers submitting electronic claims for MA PPO and MA HMO members may experience duplicate claim rejections if claims are resubmitted within 90 days of a previously processed claim that includes the exact data for the same patient and date(s) of service. BCBSTX Medicaid claims may also reject as duplicate claim submissions, but only if they are resubmitted within 24 hours of a previously processed claim. However, duplicate claim rejections should not occur if the following elements are different on the resubmitted claim:

  • Patient Control Number (Loop 2300 – CLM01 Data Element)
  • Clearinghouse Trace Number (Loop 2300 – REF02 where REF01=D9)
  • Line Item Control Number (Loop 2400 – REF02 where REF01=6R)

On April 13, 2017, an issue was identified where duplicate claim rejections occurred inaccurately for some electronically resubmitted government programs claims. This issue was resolved for BCBSTX Medicaid claims on May 3, 2017, and for Medicare Advantage claims on June 14, 2017, allowing these claims to process appropriately based on the elements referenced above. If you experienced this issue, the impacted claims may now be resubmitted for processing.

We apologize for any inconvenience this issue may have caused. If you use a billing service or clearinghouse, please share the above information with your vendor. As a reminder, providers should avoid submitting the same claim multiple times to avoid duplicate rejections.