Denial Reason, Reason/Remark Code(s)
• M-80, CO-18 – Duplicate Service(s): Same service submitted for the same patient, same date of service by same doctor will be denied as a duplicate
• Procedure codes: 93010, 71010, 71020
First: Verify the status of your claim before resubmitting. You can determine the status of a claim through the Palmetto GBA Online Provider Services (OPS) tool or by calling the Palmetto GBA Interactive Voice Response (IVR) unit.
Online Claim Status Verification through OPS
• All providers that have an EDI Enrollment Agreement on file may register to use this tool. If you haven’t already registered, please consider doing so.
• Access the introductory article to learn more by selecting the ‘Introducing Online Provider Services’ graphic on the top of any of our main contract Web pages
• Please note: Only one provider administrator per EDI Enrollment Agreement/per PTAN/NPI combination performs the registration process. The provider administrator can then grant permission to additional users related to that PTAN/NPI.
• Billing services and clearinghouses should contact their provider clients to gain access to the system
• Specific instructions for accessing claim status information through OPS are available in the OPS User Manual (PDF, 3.6 MB)
• Submit multiple ‘identical’ services on the same claim. Use the quantity field to reflect the number of services. If the services cannot be submitted on a single claim, use Procedure modifier 76 and specify the exact times of each service.
• On electronic claims use the documentation record to specify the exact times that each diagnostic service (e.g., chest x-ray, EKG, etc.) was done
• On electronic claims use the documentation record to explain why more than one diagnostic service was done on the same date by the same provider
• Attachments (e.g., signed radiology reports, signed EKG reports, etc.) for paper claims must identify the patient’s name, Health Insurance Claim number, date of service and other pertinent information (e.g., times):
o Attachments must be a full page (8 ½ x 11)
• On appeal signed medical records (e.g., radiology reports, EKG reports, etc.) may be sent as evidence to show why more than one diagnostic service was billed on the same date by same or similar providers from the same group
• Access specific instructions for documenting and submitting Procedure code modifier 76 through the Palmetto GBA Modifier Lookup. Select ‘Browse by Topic’ on the left side of the Palmetto GBA Web page.