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Multiple Crossover Claims in Medicaid Cycle 2356

EMedNY reports that due to a Centers for Medicare and Medicaid Services (CMS) systems issue, eMedNY received duplicate crossover claim files that were processed in Medicaid payment cycle 2356, which has a check date of Oct. 17th and is scheduled for release on Nov. 2nd. As a result, providers may see duplicate claims denials on their remittance statements for that cycle. If the first processed claim paid, the duplicate claim will deny with eMedNY edit 00705 DUPLICATE CLAIM IN HISTORY.

If you receive the electronic 835 Healthcare Remit Advice (ASC X12N/005010X221), below is the Health Insurance Portability and Accountability Act (HIPAA)-related message for edit 00705 that will be relayed on the 835:

  • Claim Adjustment Group Code (CAGC): CO – Contractual Obligation
  • Claim Adjustment Reason Code (CARC): 97 – The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.
  • Remit Advice Reason Code (RARC): M86 – Service denied because payment already made for same/similar procedure within set time frame.

While providers will see the denials of duplicate claims, they need to take no further action.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841