Adding a Suspect Duplicate Criteria

To add a suspect duplicate criterion:

From the Reference tab menu, click the Suspect Duplicate hyperlink.

The system displays the Suspect Duplicate Criteria List page.

Select Add.

The system displays the Add Suspect Duplicate Criteria dialog. This dialog is where you set the criteria flags for determining a suspect duplicate and where you select the program, current claim type, and history claim type to which the criteria applies.

Select the program from the Program drop-down (required).
Select the current claim type from the Current Claim Type drop-down (required).
Select the history claim type from the History Claim Type drop-down (required).
Select the error code to apply to the criteria from the Error Code drop-down (required).
In the Equal/Not Equal fields, check the checkboxes for the attributes to be checked for duplication.
Enter or select the “from” date in the From Date field (required).
If applicable, enter or select the “to” date in the To Date field.
If applicable, check the checkbox for Overlapping Dates of Service.
Type comments in the Remark text box as needed.
If applicable, check the Bypass Indicator checkbox.
Select OK.

The system exits back to the Suspect Duplicate Criteria List page where the new criteria is listed with a status of “In Review.”

Adding a Suspect Duplicate Criteria

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