Avoid "Duplicate" rejections !

mgbrousse
Jun 17
3 min read

By Martine G. Brousse (not AI!)

"The Medical Bill Whisperer"™

Patient Advocate, Certified Mediator

AdvimedPro

June 17, 2025

Too many claims – especially out of network invoices submitted by patients to their insurance for reimbursement – are labelled “duplicate” and rejected for processing or payment.

What does this mean exactly? How to avoid such denials and how to take proper action are topics explored here.

A. What does "duplicate" mean?

It means that the insurance claim processing system shows a specific claim or invoice was submitted on (at least) 2 separate occasions, and therefore that one of those is being dismissed. It also means that the same claim/invoice is already finalized, in process, or pending additional info or documentation.

A “duplicate” notification means that specific claim or invoice will not be paid.

B. Common reasons for “Duplicate” rejections:

1. It really is a "duplicate"

· You and the medical provider submitted the same claim

· You or the medical provider did not wait enough time to allow processing to finalize (usually at least 30 days from date of receipt of the claim/invoice)

· You or the billing office failed to follow up first, and the claim was already in the insurance’s system

· The claim was processed under another provider’s name

· The claim is “pending”, and needs additional time, data, documentation or info to finalize.

2. The 2nd submission was a “correction”

· The 2nd submission did not clearly indicate “corrected claim/invoice” and was assumed to be the same document by the insurance system

· What specific info/detail/data had been corrected was not clearly indicated (I know, stupid but necessary)

· Original claim was appealed, with corrections made under that process at the same time as a corrected claim was re-submitted

· A direct response to an insurance inquiry is required, not a new submission

3. Original claim/invoice is “hidden”

· It is in process or pending, but does not yet show on the portal’s EOB list

· It is being reprocessed but does not yet show on the portal’s EOB list

· It was processed under a different provider’s name

· It relates to mental health, which often does not show on the portal’s EOB list

· It relates to a dependent’s claim, which may require special authorization to view on parent’s or subscriber’s portal

C. What should you do?

1. Have patience

· Most insurances can legally take 30 days to process a claim or invoice, and sometimes longer for out of network services.

· Confirm receipt of an invoice or claim on the portal’s EOB list or upload list

· Call your insurance’s automated Claim Check system to confirm receipt

2. Find out why

· Communicate with medical providers: who will submit and do the follow up ?

· Check every “duplicate” rejection against another “paid” or “processed” EOB. Insurances make mistakes. For example, a large claim may be divided into smaller “chunks” and incorrectly rejected as “duplicate” when processed.

· Corrected claim may have been misread as Duplicate, if system only looked at date of service and provider's info

· Calling the Claims dept at the insurance should get such errors sent back for processing without the need to file an appeal.

· Was a request sent to clarify the first submission ever returned? (medical records from the office, or a questionnaire to you - i.e accident info, other insurance info..)

3. Investigate further

EOBs can show another provider’s name after processing, which can cause confusion and an avoidable resubmission:

· Group or medical practice name instead of individual Doctor's name

· For out of network services, check out “not on file provider”, “pay to member”, even Test purchase” EOBs

· “Patient view only” usually refer to mental-health claims or other restricted categories, or claims for dependents.

As a general rule, remember that while resubmitting the same claim/invoice is the easiest, fastest way to get the task off the to-do list, it is also the quickest way to get a denial... and no payment !

As always with healthcare, a little time and effort usually bring about the best results.

Martine Brousse was a long-time Billing Manager for Physicians before switching to the side of patients in 2013. The move has allowed her to apply her deep expertise and vast experience of the intricacies of resolving all types of medical bill and claim payment issues in ways that directly and positively impact her clientsʻ finances.