CO-18 Denial Code Description: Exact duplicate claims or services.
Insurance companies operating in the US deny duplicate claims using the denial code CO-18 with a remark ‘Duplicate Claim/Service’. The main reason behind the rejection is when healthcare providers submit multiple claims for the same service or the same service is provided multiple times a day without an appropriate modifier, such as 59, 76, or 91.
Duplicate billing issue also arises when the primary payor sends the claim to the secondary payor for reimbursement. In such cases, providers can review the electronic remittance advice (ERA) to confirm whether the primary payer has already forwarded the claim.
To prevent duplicate claim submission and avoid CO-18 denial code, healthcare providers must:
- Integrate a tracking tool or reliable system to check for submitted claims
- Educate the in-house team to check the existing claims prior to resubmission
- Conduct periodic audits of your billing cycle to analyze patterns of duplicate submissions
What Exactly Is the CO-18 Denial Code?
Denial Code CO-18 signifies a denied claim from the payor with a remark ‘Duplicate Claim/Service’. It informs the healthcare provider that the payor has detected that the claim sent is a copy of a claim previously submitted. Payors deny such claims when they identify billing of the same service more than once for the same patient within a short span of time.
Simply put, the code shows to the providers that they have resent a claim that has already been reimbursed or is in process.
What Does a Duplicate Claim Include?
If a claim submitted by the provider matches the one that has already been sent, it will be considered a duplicate claim and met with a CO-18 denial. They determine the duplicate claim based on various similarities and data included, like:
- Date of Service
- Type of Service
- Provider Number
- Procedure Code or CPT
- Place of Service (POS)
- Billed Amount
Note: Keep in mind that all claims denied on the account of duplicate details may not be valid. Sometimes, patients do receive distinct medical services that are billable. The bills for these services may seem like duplicates, when in reality they aren’t. This is where providers must pay full attention to CPT codes, modifiers, and clear documentation.
Examples to Simplify CO-18 Denial Code
Consider these examples to better understand the concept of duplicate claims.
Example 1: A patient suffering from acute pain gets physiotherapy treatment from two different therapists on the same date at the same practice, clinic, or hospital. Due to a lack of communication or without confirming, they both sent claims to the payor for reimbursement.
Now, you know that the information in both the claims will be almost the same, like the type of service offered, the date or day of service, and the place of service. After reviewing the claims, the payor will reject the latter using a CO-18 denial to show that they’ve already received a bill containing the same details for the same patient and services provided on the same date.
Example 2
Suppose a patient in the state of Arizona visits a cardiology practice for a routine checkup. The cardiologist’s billing team creates a claim for a standard consultation. They resubmit a claim after not getting any updates from the payor for a week, assuming the original claim was never received.
They don’t have any idea that the original or first claim is still under processing. In this situation, the insurance company may flag both entries as duplicates using the denial code CO-18.
Common Reasons for Receiving CO-18 Denial Code
As far as the causes behind the triggering of CO-18 denial are concerned, there could be many. We’ve briefly explained some of the main reasons here. For effective resolution and efficient prevention, it is imperative that you understand these mistakes. It helps you stay compliant and extract full revenue against the provision of medical services.
Duplicate Claims
Sending a duplicate claim is the most obvious of all the CO-18 denial reasons. If you submit the exact same claim for reimbursement, knowingly or by mistake, the insurer is not going to pay for it. It normally occurs when the provider or their team accidentally sends the same claim more than once. It could either be due to a system error or human negligence.
Software Glitches
Another common reason behind the CO-18 denial code, apart from human error, is a software issue. Humans are bound to make mistakes and may submit the claim twice without realizing. The billing software can malfunction, too. This way, you may have to deal with unintentional duplicate claims. Update software regularly and invest in the latest software tools that have round-the-clock support. Also, train your staff to troubleshoot common software bugs.
No Coordination Between Departments
Interdepartmental and intradepartmental coordination is the key to success in the medical billing industry. If there’s no communication between the departments, the result could be submitting the same claim without knowing it has already been sent to the payor. Ensure that your teams, like billing, coding, and front desk staff, work together as a cohesive unit.
Bilateral Procedures Without Modifiers
As a healthcare provider or someone responsible for creating claims and submissions, you cannot overlook the modifiers. Adding separate claims for bilateral services or procedures without appending the exact modifiers means that the claim goes unpaid. For instance, a claim about surgery on both legs must include precise modifiers, such as 50, RT, or LT.
Not Updating Claim Information
If the provider fails to update essential information on the claim, i.e., misses something significant like a modifier, mistakenly adds another date of service, or doesn’t add patient history, it may result in a denial because the payor will consider it a duplicate claim. To avoid CO-18, ensure that your claim is flawless with every detail up to date.
Not Knowing the Payor Guidelines
Different payors have different submission guidelines, and a lack of acquaintance with these regulations can lead to denials and loss of revenue. When providers submit claims with no understanding of the payor policies, chances are that the claims will end up as denied. For instance, some payors deny claims submitted before the customary waiting period.
Comparison of Denial Code CO-18 With Related Denial Codes
| Denial Code | Meaning | Why It Happens (Common Cause) | Who Fixes It | How to Fix (Resolution Strategy) |
| CO-18 | Duplicate Claim/Service | The same claim or service was sent more than once. | Billing staff, coding team | Double-check claims and correct them before sending again. |
| CO-22 | Non-Covered Charges | The insurance plan doesn’t cover this service. | Billing staff | Review the insurance policy. If needed, file an appeal. |
| CO-50 | Not Medically Necessary | Insurance says the service wasn’t needed for the patient. | Healthcare providers | Send extra documents to prove why the service was needed. |
| CO-45 | Charges Exceed Fee Schedule | The billed amount is higher than what the insurance allows. | Billing staff | Adjust the bill to match the payer’s allowed amount. |
| CO-97 | Service Not Paid Separately | The service is already included in another procedure (bundled). | Billing staff, coding team | Check coding rules. Use the correct modifier if the service should be billed separately. |
| CO-16 | Missing Information | Some required info (like patient details, codes, or documents) is missing from the claim. | Billing staff | Review the claim, add the missing details, and resubmit. |
Why Quick Resolution of CO-18 Is Necessary?
Quick resolution of CO-18 denials is essential as it not only eliminates denials and helps you stay compliant with HIPAA, state-specific and federal regulations. Rejected claims are converted into dollars, lowering the frustration of the providers, allowing them to enjoy financial stability.
Here are some reasons why CO-18 resolution is necessary:
Loss of revenue
Medical claims that are denied mean delayed or denied revenue for providers. If the resolutions are not made accordingly or resubmissions are delayed, loss of revenue can disrupt your operations and result in stress and anxiety.
A steady flow of income
Claims not getting approved in the first attempt mean delayed payments. However, resolving them appropriately means you get what you deserve without waiting long. A steady flow of income is what every provider wants, and you should too.
You stay compliant
An increasing number of denials, be it due to CO-18 or any code, can lead to compliance issues. It affects your practice’s credibility, and if not resolved or taken seriously, too many denials can lead to litigation and even fines, which can be detrimental for your practice.
Prevents Backlog
When you are not careful while creating claims, collecting supporting documentation, not appending the correct CPT codes or modifiers, or don’t heed other technicalities, denials keep on rising. They increase backlog and put undue work pressure on you and your team, affecting everyday tasks.
Quality Care for Patients
As a healthcare provider, when you’re not worried about denials and are sure that you’ll pocket complete revenue on time, you’re better able to focus on your primary job. You provide timely and quality care to patients, turning them into happy and satisfied clients.
Improves Provider-Payor Relations
Another important benefit of the quick addressal of the CO-18 denial code shows professionalism on your end. You’re chasing insurance companies for payments, and neither are you wasting their time. This way, the relation between you and the payor strengthens over time.
Risk of Permanent Revenue Loss
If you don’t fix denied claims quickly by not applying corrective measures within the resubmission timelines, you may exceed the deadlines. This way, you have to go around, use more resources and energy for payment collection. Still, you may face permanent loss of reimbursements.
How to Prevent Co-18 Denials?
Resolution or the quick addressing of CO-18 denial is not the main goal. Your primary aim should be to prevent these denials from happening. For this long-term solution, you need to be proactive and implement measures that help you in the times to come. If you want to prevent the CO-18 denial once and for all, follow I-Med Claims’ tried and tested methodologies.
Carefully Review the Claims Before Pushing
Set up a billing cycle that is smooth and seamless. Define clear roles of the staff and assign them different duties. They must carefully review every aspect of the claim before the final push. They must be experienced enough to know which modifiers must be included and identify any errors or duplicate services that could result in CO-18 denial.
Never Compromise On Documentation
Proper documentation is the key to success. Paying attention to even the minute details and gathering the exact documents ensures that you stay safe from CO-18 denials. Record everything from the moment a patient books an appointment until the treatment is over. Every service, procedure, or equipment used, dates of service, and everything in between. Documentation helps you avoid and identify duplicate claims.
Enhance Communication and Coordination
Promote teamwork and clear communication across all departments. Everyone involved in revenue cycle management, from healthcare providers to the billing team, medical coding experts to front desk staff, should work in close collaboration and fulfil their roles to prevent the CO-18 denial code.
Integrate Practice Management Software
A broken billing cycle will never get you far, even if you’re extremely careful in claim creation. Make sure to streamline your revenue cycle by integrating modern tools and software solutions. Automate the billing, error rectification processes, coding, and other processes. Keep a track of the submission dates so you never lose track of the claim and payments.
Invest in Staff Training
To ensure that your staff is up to date with the latest trends, software tools, and denial techniques, educate them. Invest in the training of billing and coding specialists, denial management experts, front desk staff, and everyone involved in your revenue cycle. Educate them on how to prevent errors and how to ensure flawless submission to avoid duplicate claims.
Implement A Claim Tracking System
Monitor claim submission status and follow up on claims progress with the payors. Only this way can you track the claim statuses, i.e., claims reimbursed recently, claims submitted but awaiting approval from the payor, claims waiting to be submitted, denied ones, and so on. Follow up on unpaid claims, in case there are issues, rectify them, and ensure you get reimbursed.
What to Do If You Receive A CO-18 Denial?
If you receive a CO-18 denial from the payor, you can appeal against the decision. We’ve shortlisted some basic points on how to make an appeal.
Examine The Claim
Start your appeal process by thoroughly reviewing the denied claim. Make sure you don’t miss a single point or data included, as it will enable you to detect why it was denied by the payor. Experienced denial management experts examine errors in the claim and conclude if there’s an error from the payor side or if it is really a duplicate submission.
Collect Necessary Documentation
Once you carefully examine and review the details, collect all the supporting documentation that can help you overturn the decision and help you in the appeal process. It must include the patient’s past and present medical records, previous claims, procedure details, and communication with the payors.
Submit an Appeal to The Payor
Make a proper document including all the details of the claim and clearly address the reasons for denials outlined by the payor side. Explain why the denial was inappropriate and the reasons it should be reconsidered. Don’t forget to include the supporting documentation and any evidence.
Follow Up with The Payor
Once you’ve submitted an appeal through a formal channel, follow up on it regularly with the payor to see the status. Start by conducting a telephonic conversation fifteen days after the appeal, and make sure that the relevant department is on it.
Learn from Denials
Denial resolution and prevention can pave the way to smooth reimbursements and timely future payments only if you’re ready to learn from denials. Think of each denial as a chance to improve. Look at what went wrong, fix the mistakes, and make changes so the same issue doesn’t happen again.
Financial Impact of CO-18 Denial Code
Any denial has a serious impact on your revenue generation capabilities. If you’re not careful and don’t learn from mistakes, you’ll keep losing revenue and credibility. Moreover, denials mean that medical practices, clinics, hospitals, or any healthcare facility doesn’t comply with HIPAA, payor guidelines, and other basic regulations. It can seriously impact your finances and credibility.
| Potential Lost Revenue | Average Time to Resolve | Staff Hours Involved | Frequency by Payer Type |
| $200-$500 per claim | 2-4 weeks | 2-5 hours | Varies by payer |
It is important to note that the numbers included in the table, like the time and rates, are not exact. They may vary based on the state in which a medical facility is located, its size, patient volume, medical specialty, and claim complexity, etc.
Final Words
In the end, it is critical to know that any kind of denial isn’t feasible for healthcare providers. They cannot afford to ignore any denial, especially the denial code CO-18. Moreover, if you’re facing continuous CO-18 denials and losing money, your billing cycle needs to be revamped.
Only a customized and seamless revenue cycle can optimize your processes, eliminate errors, mitigate denials, maximize your revenue collection, and minimize leaks. If you want to get rid of CO-18 denials permanently, consult I-Med Claim. We’re one of the best medical billing companies in the US, with multiple offshore offices, enabling hundreds of specialty practices to earn more than their competitors.
Owing to a highly experienced, industry-certified, and skillful team of medical billing and coding specialists, we know how to turn down denials and raise your claim acceptance rate. The best part of collaborating with I-Med Claims is that we’re the most affordable third-party revenue cycle management company, promising you enhanced reimbursements without any delay.
Partner with I-Med Claims today and see how we customize your billing cycle to enhance your productivity and revenue. With us as your billing partner, you can focus on providing exceptional medical service to care seekers while we handle the hectic administrative tasks.
