How To Fix Denial Code 18 | Common Reasons, Next Steps & How To Avoid It

Denial Code 18 (CARC) means that a claim or service has been denied because it is an exact duplicate of a previous claim or service. Below you can find the description, common reasons for denial code 18, next steps, how to avoid it, and examples.

2. Description

Denial Code 18 is a Claim Adjustment Reason Code (CARC) and is described as ‘Exact duplicate claim/service’. This code is used when a claim or service is identified as an exact duplicate of a previous claim or service that has already been processed and paid. Insurance companies will not make payment for duplicate claims or services, as they have already been addressed and accounted for.

2. Common Reasons

The most common reasons for denial code 18 are:

1. Data Entry Errors: Duplicate claims or services can occur due to data entry errors, where the same claim or service is submitted multiple times by mistake. This can happen when there are issues with the billing system or human error during the claim submission process.
2. System Glitches: Technical glitches or system errors can also result in duplicate claims or services being submitted. This can happen when there are issues with the electronic claims submission system or when there are communication errors between the provider’s system and the insurance company’s system.
3. Lack of Communication: In some cases, duplicate claims or services can occur due to a lack of communication between different departments within a healthcare organization. This can happen when multiple departments or individuals submit the same claim or service without realizing that it has already been processed.
4. Unawareness of Previous Claims: Providers may sometimes be unaware that a claim or service has already been submitted and processed. This can happen when there are delays in receiving payment or when there are issues with the claims tracking system.

3. Next Steps

You can fix denial code 18 as follows:

1. Review Claim History: First, review the claim history to determine if the claim or service in question is indeed a duplicate. Check if the claim has already been processed and paid, and if so, identify the reason for the duplicate submission.
2. Investigate the Cause: Identify the cause of the duplicate claim or service. Determine if it was due to a data entry error, a system glitch, a lack of communication, or any other underlying issue. This will help prevent similar errors from occurring in the future.
3. Contact the Insurance Company: If the duplicate claim or service was submitted in error, contact the insurance company to inform them of the mistake. Provide them with the necessary information, such as the claim number and the reason for the duplicate submission. They will guide you on the next steps to resolve the issue.
4. Correct the Error: If the duplicate claim or service was submitted due to a data entry error or a system glitch, correct the error in your billing system or electronic claims submission system. This will help prevent similar errors from happening in the future.
5. Improve Communication: If the duplicate claim or service was a result of a lack of communication within your organization, take steps to improve communication between different departments or individuals involved in the claims submission process. Implement protocols and systems to ensure that all claims are properly tracked and monitored.

4. How To Avoid It

You can prevent denial code 18 in the future as follows:

1. Implement Quality Control Measures: Establish quality control measures within your organization to ensure that duplicate claims or services are not submitted. This can include double-checking claims before submission, implementing automated checks for duplicate claims, and providing training to staff on the importance of avoiding duplicate submissions.
2. Improve Data Entry Accuracy: Enhance data entry accuracy by implementing validation checks and error detection mechanisms in your billing system. This will help identify and prevent data entry errors that can lead to duplicate claims or services.
3. Enhance Communication: Improve communication between different departments or individuals involved in the claims submission process. Implement clear communication channels and protocols to ensure that everyone is aware of the status of claims and services.
4. Utilize Technology: Leverage technology solutions, such as claims management software or electronic claims submission systems, to streamline the claims submission process and reduce the chances of duplicate submissions.

5. Example Cases

Below are two examples of denial code 18:

• Example 1: A healthcare provider accidentally submits the same claim for a patient’s office visit twice due to a data entry error. The insurance company denies the second claim under denial code 18 as it is identified as an exact duplicate of the first claim.
• Example 2: A hospital’s billing department submits a claim for a surgical procedure that has already been processed and paid. The insurance company denies the claim under denial code 18 as it is identified as an exact duplicate of a previous claim.

Source: Claim Adjustment Reason Codes