Duplicate Detection

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Inpatient and OutPatient Duplicate Detection rules provide automated denials for definite duplicates and flexible workflows for handling potential duplicates.

Duplicate detection rules can be controlled by individual trading partner and specific client controls. If you are managing an adjudication work-flow, you would likely ask the system to deny the claim to the provider… if you are a PPO, you would likely want to ensure you report the claim or service as a duplicate, but provide the partner with the original pricing.