Duplicate Claims for Drugs

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Duplicate Claims for Drugs


Date Issued:  06/16/2021


Effective September 15, 2021, EmblemHealth has instituted a payment policy for duplicate claims for drugs. A duplicate claim is defined as a claim or claim line that has been previously processed for payment. When a provider submits the same drug code for the same date of service, and the same number of units, typically given once a day or less frequently, then the second drug code will be denied as a duplicate claim.