You use Duplicate Check in the Adjudication function of Claims to set up the criteria ND MMIS uses in the duplicate check process to identify situations where it is not allowed to bill the same service multiple times.
The duplicate check process compares all paid claims that were previously adjudicated and all to-be-paid claims still in adjudication to the claim that it is currently adjudicating (the 'in-process' claim or line item) to determine whether a duplicate claim or line item has been billed. Denied, to-be-denied, and suspended claims are not considered in the duplicate check process.
Claims are evaluated at the claim header and line item level. When a duplicate claim or line item is identified, the exception code you indicate in the duplicate check criteria is applied.
To determine if duplicate check processing is required for the procedure code on the in-process line item, the Duplicate Check General Indicator on the Procedure Code page in the Code Maintenance function of Rules Management is referenced. After this determination is made, the process uses the criteria you establish on the Duplicate Check Criteria page to identify situations where it is not allowed to submit the same service on different lines of the same claim and applies the indicated exception code.
Next, the process identifies situations where it is not allowed to submit the same service on different claims and applies the indicated exception code.
Additionally, the process identifies situations where the same claim has been submitted more than once and applies the indicated exception code.
When setting up duplicate check criteria, you can use an exception code multiple times, but the criteria must be unique for each use.
You can rank the duplicate check criteria. Rank defines the order of precedence ND MMIS is to use for evaluating duplicate check criteria. The lower the numerical value assigned to the rank, the higher its precedence. This means duplicate check criteria with a rank value of 20 is evaluated after a duplicate check criteria with a rank of 10 for a given exception code.
You cannot delete duplicate check criteria if ND MMIS has used it in processing claims. This ensures that a historical record of the duplicate check criteria is kept for research purposes. You can void the criteria if it is no longer valid.
How to Add or Edit Duplicate Check Criteria
How to Void Duplicate Check Criteria
How to Delete Duplicate Check Criteria
Version as of 5/16/14.
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