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OA 18 Denial Code

We understand that managing the complexities of medical billing can be daunting. One of the majorly occurring problems includes denials with the OA 18 codes. This blog will unravel everything you need to know about OA 18. We will explain its common causes and how to avoid it.

Read on to understand how Health Quest Billing can help you prevent these denials.

What is OA 18 Denial Code?

Insurance companies can also assign the denial code OA 18 to claim denials. This code indicates that the relevant reimbursement claims or their services are duplicate. They are being submitted as exact duplicates of some previous ones. Insurers typically associate this denial code with the Group Code OA.

This association signifies that the claim denials of this code are related to other insurance coverages. However, there can be certain cases in which the compensation regulations of state workers require it. In this case, the denial code 18 is primarily used with the Group Code CO.


OA 18 Denial Code

Common Reasons for the OA 18 Denial Code

There can be various reasons as to why healthcare providers receive reimbursement claims with the OA 18 denial code. Here is a description of the major reasons:

  • Duplicate Submission

This situation arises when the same claim is inadvertently submitted more than once. It can be submitted by the healthcare provider or billing office. During data entry, a staff member may accidentally enter and submit the same claim twice. Billing software may also experience issues or malfunctions.

They can result in the same claim being submitted multiple times. A provider may submit a claim for a patient’s consultation on two different occasions. They may be thinking that the initial submission either failed or was not processed.

  • Crossover Claims

Crossover claims involve both the primary and secondary insurance companies. Both receive the same claim where the primary one processes the claim first. The claim is then sent to the secondary one for additional processing or payment.

The secondary insurer may also receive the original claim directly from the provider. It might be flagged as a duplicate which can lead to an OA 18 denial. Some patients can have Medicare as primary insurance and Medicaid as secondary insurance.

Their reimbursement claim may be processed by Medicare. In this case, the same claim is sent directly to Medicaid by the provider. As a result, the patient will end up with a duplicate claim denial.

  • Corrected Claims Resubmitted Without Proper Identifiers

When providers resubmit corrected claims, they must include appropriate identifiers. These identifiers distinguish the corrected claim from the original. Some providers may fail to mark the claim as corrected. They may also not provide a reference to the original claim number.

These actions can result in it being flagged as a duplicate. A provider resubmits a claim with corrections for coding errors. They do not indicate that it is a corrected claim. This leads to a denial as a duplicate submission.

  • Multiple Providers Submitting Claims for the Same Service

Different providers may submit claims for the same service. This service is provided to the same patient on the same date. These different healthcare providers are involved in the patient’s care. They might bill for the same service.

Inadequate communication among healthcare providers may lead to this irregularity. These providers are responsible for billing specific services. Both a primary care physician and a specialist submit claims for the same diagnostic test. This test is performed on the same day.

  • Billing for Bundled Services Separately

Some services are meant to be billed as a bundle. If billed separately, they can trigger a duplicate denial. Healthcare providers bill separately for services that should be included in a single bundled code.

Providers may be unaware that certain services are considered bundled under a single code. A surgical procedure and its postoperative care are billed separately. In this case, they should be billed using a bundled code.

How to Avoid OA 18 Denial Code?

The OA-18 denial code signifies duplicate service submissions in medical billing. Here’s how to minimize encountering this code:

OA 18 Denial Code

  • Focus on Accurate Claim Submission

Implement a system for internal review of claims before submission. This allows staff to identify and remove any duplicate entries. This should happen before they reach the insurance company. Utilize reliable electronic billing software with built-in duplicate claim detection features. These programs can help flag potential duplicates based on patient information.

Other factors include procedure codes and service dates. Train your billing team on proper claim submission procedures. This emphasizes the importance of verifying all information and avoiding duplicate entries.

  • Understanding Duplicate Claims

Be aware that duplicate claims involve submitting the exact same information. Such information is submitted for the same patient, service, and service date. This could be due to accidental resubmission or a technical error.

In some cases, a claim might be flagged as a duplicate even if there are minor discrepancies. This could happen if the place of service or modifier code differs slightly between submissions.

  • Preventing Duplicate Submissions

Consider integrating your billing software with your patient scheduling system. This can help prevent accidental duplicate billing for services already scheduled. Maintain a system for tracking claim submission status. This allows you to monitor if a claim has already been submitted and avoid resubmitting it.

Encourage clear communication between providers and billing staff. A service can be rescheduled or some changes can be made to the procedure details. The billing team should be informed promptly to avoid submitting a duplicate claim.

How Health Quest Billing Helps Prevent Claim Denials?

Health Quest Billing employs advanced claim scrubbing software. It reviews each claim for errors before submission. This software checks for common mistakes such as incorrect codes. Other mistakes include missing information and discrepancies in patient details.

Health Quest Billing also ensures all necessary documentation is attached before submitting claims. This includes referral notes and prior authorizations. There can be other supporting documents required by insurers as well.

Regular internal audits are performed to identify patterns. There are other recurring issues identified that as well may lead to claim denials. This proactive approach helps to address problems before they become widespread. We also develop and implement corrective action plans to prevent future occurrences.

This may include additional training or process adjustments. Our experts provide hospitals with detailed reports on claim statuses, denials, and trends. These reports help hospital administrators understand where issues may be occurring.

They may also understand what corrective actions are needed. Utilizing data analytics, Health Quest Billing identifies patterns in claim denials. We also provide actionable insights to improve future claim submission processes.

Can the Denial Code Co 18 Be Ignored?

You cannot ignore this code. There are a lot of CO 18 denials received by hospital clients. There is a large number of reimbursements on the line as well. However, that number can be considered as loss revenue. This code deals with duplicate claim submissions.

So, most of these claims may have already been submitted at one point. Insurance companies provide this information to healthcare organizations through their denials. In reality, a very small percentage of that number includes the reimbursements that matter to hospitals. This means that some duplicates of those may not be true.

As a result, healthcare providers may require strict staff reviewing and verification. Receiving such denials and reviewing and resubmitting them are two different cases. Healthcare organizations must review the resources utilized with verifying and resubmitting their CO 18 denials. These denials are worth that extra effort.

The Bottom Line

Understanding the OA 18 denial code is crucial for healthcare providers to prevent revenue loss. This loss of revenue happens as a result of duplicate claims. Hospitals must implement thorough review processes and utilize advanced software.

They should maintain clear communication to significantly reduce these denials. Contact Health Quest Billing to ensure all these actions are taken to save your claims from getting denied.

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Frequently Asked Questions (FAQs)

The OA-18 code stands for duplicate services. The same service submitted for the same patient is denied as a duplicate.

The full form of OA is Other Adjustments whereas CO stands for Contractual Obligation. There is another term PR that stands for Patient Responsibility.

The OA codes are part of The Group, Reason and Remark Codes. They are HIPAA EOB codes that are cross walked to Explanation of Benefits codes.

What is OA adjustment? An OA adjustment involves the usage of the OA denial code. In this case, the relevant reimbursement claim is paid in full at initial adjudication with reason code 23.

You should implement a system for internal review of claims before submission. This allows staff to identify and remove any duplicate entries.