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ACKNOWLEDGEMENT/RETURNED AS UNPROCESSABLE CLAIM THE CLAIM/ENCOUNTER HAS BEEN REJECTED AND H - Humana

Rejection Message Rejection Details Resolution

ACKNOWLEDGEMENT/RETURNED AS UNPROCESSABLE CLAIM  THE CLAIM/ENCOUNTER HAS BEEN REJECTED AND H

Note: This rejection message and solution is specifically for claims billed to Humana.

 

Payer Rejection:

The actual rejection in their system is: DUPLICATE OF A PREVIOUSLY PROCESSED CLAIM/LINE

When claims reject at the payer for "DUPLICATE OF A PREVIOUSLY PROCESSED CLAIM/LINE", it means that the payer has received the exact claim before or they have received the exact service before.

Submitter Action:

Contact the payer to verify the status of the previous claim submission and determine if the claim needs to be corrected and (if so) how to properly resubmit.

There are two potential resolutions:

1. Update the encounter (if necessary) so that it is not being resubmitted with the exact same information as the previous submission. 

2. If the claim needs to be resubmitted as a corrected claim (per payer request), follow the instructions below to enter the submit reason on the encounter:

  1. Click Encounters > Track Claim Status.
  2. Look for and double-click on the encounter that needs correcting.
  3. On the Edit Claim window, double-click on the Encounter number. 
  4. Click the arrows next to Miscellaneous to expand.
  5. Select the correct “Submit Reason” code.
  • If the submit reason is “7” enter the Payer Doc Ctrl #.

6.  Click Save.

Then, rebill and resubmit all affected claims.

Note: The submit reason code depends on the payer's requirements. For example, Medicare will not accept any Claim Submission Reason Code other than “1 –Original.” Do not change the Submit Reason unless you are certain the payer needs it changed.