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Medicare claiming with the same item code
Medicare claiming with the same item code

A Medicare or DVA claim has been rejected as a duplicate item, but it isn't. Here's how to fix that.

Nick avatar
Written by Nick
Updated over a week ago

To view the Medicare or DVA response code for a claim that you may believe was rejected in error you can select the "Invoices" tab, and select the desired invoice.

At the bottom of a rejected claim, under the "Service Items" section, you will see the following error message: "162 - Benefit has been previously paid for this service"

There are two reasons why you might get this error message:

  1. You have inadvertently put in the claim for the same item for the patient twice by mistake with the same service date.

  2. There is a need to claim for the same item, same service date more than once but the claim was not configured correctly.

For many Medicare items there is a need to claim for the same item twice (or more) on the same service date. For this type of item, Medicare requires you to set a code to let them know that this isn’t a duplicate claim and add some “Service Text” in the appropriate box to explain why.

You will quite often see this scenario where you may, for example, need to do a test on both the left and right ear (and the medicare item code is ‘per ear’).

If you do not set the code for these items, you may receive the rejection message on the second or subsequent items with the same item code and service date: "162 -Benefit has been previously paid for this service"

Claiming multiple item codes at once that are not duplicate services

To let Medicare know up-front that this is not a duplicate claim you need to set a flag or code called the ‘Duplicate service override code’. To do that in Tyro Health Online:

  1. Add your (multiple) item codes to the claim for the patient.

  2. For all of the item codes where there are multiple of the same item code and same service date, select 'Show Optional Attributes'.

  3. From the options available, set ‘Duplicate service override’ to ‘Not duplicate’. When this code is set, it is advisable to describe why in the service text box. 

There are also certain codes that you can use in the ‘Service Text’ field to help abbreviate and make use of the full available character limit. Note: you don’t have to use these codes.

Code

Description

HGL

Left

HGR

Right

HOL

Left eye

HOR

Right eye

HU2

Non-contiguous body areas

HU3

Contiguous body area with different setup required

HX1

Not for comparison

HX2

All x-rays specifically requested

HX4

Hand, wrist and forearm

HX5

Forearm and elbow

HX6

Elbow and humerus

HX7

Foot and ankle

HX8

Ankle and leg

HX9

Leg and knee

HXA

Knee and femur

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