Avoiding Duplicate Claims Submissions (For EmblemHealth, GHI and HIP Benefit Plans)
Ensuring that you get paid quickly and accurately is our top priority.
Any claim submitted more than once from the same provider or supplier for the same date of service and for the same service is considered a “duplicate” and the claim will be denied. When you resubmit claims because you haven’t received your payment or a response regarding your payment, you are actually delaying claims processing and can potentially create confusion for the member.
Also, please be aware that we can initiate a fraud investigation if we see a pattern of duplicate billing.
Just how quickly do we process claims?
- 98 percent of our claims are processed within 14 days of receipt.
- Virtually 100 percent of our claims are processed within 30 days.
Make sure that your automated billing system is set up properly.
- If you bill us electronically, please check that your billing system is not set up to automatically re-bill every 30 days.
- Please allow a reasonable amount of time for us to complete your account receivable reconciliation before you resubmit a claim. Our timely claims processing should reduce the number of claims you need to resubmit, saving you time and administrative effort and expense. Many times the payment for the original claim was applied to the copay, or the service was denied for medical necessity, eligibility, or another reason. Please make sure that your automated billing system accurately posts these types of settlements.
- Ensure that your billing system is not set up to automatically generate a paper claim. This duplicate billing practice is costly and delays claims processing.
If you need assistance, please contact your software vendor.
Make sure that you do not re-bill an underpayment.
Please do not re-bill the original claim when you believe that an adjustment to the initial payment is warranted. Should this occur, please contact our Customer Service at one of the numbers listed below.
Get tools to help you reconcile your accounts.
Access more resources on Claims Corner or call us!
- EmblemHealth benefit plans:
Call 1-877-842-3625, seven days a week (excluding major holidays), from 8 am to 8 pm. TDD users should call 711.
- GHI benefit plans:
Call 1-800-624-2414, seven days a week (excluding major holidays), from 8 am to 8 pm. TDD users should call 711.
- HIP benefit plans:
Call 1-866-447-9717, option 2, Monday through Friday, from 9 am to 6 pm. TDD users should call 1-888-447-4833.
We appreciate your cooperation in avoiding duplicate billing. By doing so, you will help to ensure that your claims are processed efficiently and in a timely manner.