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OhioBWC - Basics: (Policy library) - File

Duplicate Claims Policy

Policy Name:

Duplicate Claims

Policy #:

CP-04-05

Code/Rule Reference:

none

Effective Date:

11/14/16

Approved:

Rick Percy, Chief of Operational Policy, Analytics & Compliance (Signature on File)

Origin:

Claims Policy

Supersedes:

Policy #CP-04-05, effective 01/28/13

History:

New 01/28/13

Review date:

01/28/2018

 

 

I. POLICY PURPOSE

 

The purpose of this policy is to ensure that duplicate claims are properly identified and combined in an efficient manner to prevent duplicate actions.

 

II. APPLICABILITY

 

This policy applies to all BWC staff and managed care organizations.

 

III. DEFINITIONS

 

Alias Claim: the claim that is combined into the surviving claim.

 

Duplicate Claim: When more than one claim has the same injured worker  name, social security number, risk/policy number, and date of injury.

 

Surviving Claim: the claim that remains once the alias claims are combined.

 

IV. POLICY

 

It is the policy of BWC to identify and combine duplicate claims in a manner that avoids or corrects overpayments and creates one complete and accurate claim.

 

 


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