About a year ago, Humana Military Healthcare Services, Inc. discovered that a surprising number of providers were filing duplicate TRICARE claims in any given month; however, most providers were unaware that they were generating duplicates. Thousands of duplicate claims were identified in each quarter, and many were reviewed for potential fraud.
 
At face value, duplicate claims may not appear to be an issue from the provider’s standpoint. However, if an electronically submitted claim overlaps a previously submitted claim, it can delay processing. This often occurs with paper claims since they cannot be tracked until they are entered into the claims system. Therefore, a duplicate claim may be entered before the original and then becomes difficult to track.
 
Duplicate claims also can occur when you attempt to file a corrected claim. Responses from your remittance should tell you what has happened to the claim and suggest next steps if the claim did not result in payment. Many provider offices erroneously believe that continuing to submit the same claim will generate a different response or payment. However, the claim will continue to be rejected as a duplicate submission unless it is flagged as a corrected claim.
 
Filing the same claim more than once also may cause your office’s patient accounting department to track the duplicate as a separate claim and anticipate duplicate copayment and reimbursement. Since PGBA, LLC (PGBA), the TRICARE South Region claims processor, assigns an internal claim number to every claim that enters its door, it is very difficult for the provider’s office to get information from PGBA if
that claim has been submitted two to four times within a month.
 
Over the past year, we have discovered that one way to help resolve this issue is to file electronic media claims (EMCs). Additionally, providing a reasonable amount of time between claim cycles and ensuring timely resolution of the claim payment/response may help. By adding electronic remittance advice (ERA) and electronic funds transfer (EFT) to your claims interface with PGBA, you can post responses to and funds for your claims more rapidly and accurately. Furthermore, it appears that providers who make
transactions electronically have fewer issues with tracking their claims activity and producing duplicates.
 
To avoid submitting duplicate claims, we encourage you to log on to myTRICARE.com, our claims processing Web site for TRICARE South Region providers. This site allows you to look up previous remittances, check claims status and inquire about a claim response without introducing a duplicate. To learn more, log on to myTRICARE.com today!