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Duplicate Billing

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Occasional Contributor

Hi Everyone,

 

I am looking to create a formula that will identify duplicate billing of some claims I am working with. 

What I am looking for the formula to do is match the same patient on the same date of service that has a claim paid by different providers. 

***Duplicate billing on optical products, identify different providers billing for the same member on the same DOS for procedure code V2020 (Basic Frames). ****

Provider IDBilling Provider IDProvider NumberProvider Tax IDProvider NPI NumberProvider First NameProvider Last NameProvider Facility NumberProvider Facility NamePatient IDPatient First NamePatient Last NameDOS Begin

Received Date

112345.C123112345.C1231123454112345561999087650 PEARLE VISION CENTERC123PEARLE VISION CENTER00011111100TEXASBEASTER05-15-201905-15-2019
123456.E234123456.E2341234564177654391999087654 EYE CRAZY OPTICAL INCE456EYE CRAZY OPTICAL00022222200TEXASBEASTER05-15-201905-20-2019
134567.K345134567.K3451345672000987661999087655ASHTON DCOLEIOK789STRATEGIC MANG00033333300ARSENFORENZ09-26-201909-26-2019
145678.E456145678.E456 1456789908765431999876467 EYE CRAZY OPTICAL INCE890EYE CRAZY OPTICAL00044444400GLITZFANCY09-27-201909-27-2019
156789.K567156789.K5671567893334445551999876568ASHTON DCOLEIOK098STRATEGIC  MANG00055555500GLITZFANCY10-21-201910-21-2019
167890.E678167890.E6781678900099887761999112345 EYE CRAZY OPTICAL INCE765EYE CRAZY OPTICAL00066666600GLITZFANCY10-21-201910-23-2019
9 Replies
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@Kay_T1060 

It's hard to draw a connection between your description and the image of the data you provided. You say What I am looking for the formula to do is match the same patient on the same date of service that has a claim paid by different providers, but in what you show there's no column that specifies a date of service; nor is there a patient ID. Finally, there's a lot of different info on Providers, so it would help to know which of those columns are relevant.

 

Is it possible to upload a sample of the actual spreadsheet? Just make sure no real people (or, for that matter, real providers) can be identified.

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COUNTIFS function can help you identify the duplicate values.

Assuming you want to find duplicate values in Provide Number in column C, you can have an helper column and execute the formula =COUNTIFS(C2:C100,C2)>1.

Click Enter and copy the formula down.. The values that are duplicated will return TRUE and unique Provider Number will return FALSE.

Another way of identify duplicate values is to use the Conditional Formatting.. Although, this is bot formula based
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@mathetes  Hi, 

 

 I have attached the data that I am working with. It's a small sample, but is exactly formatted to what I am working on. 

 

I am in the end result looking for duplicate billing. The "correct" billing provider is EYE KRAZY OPTICAL. I am looking to identify the additional provider's billing for the same member on the same date of service as EYE KRAZY OPTICAL.

 

I am probably making this harder than what it is lol, but I am trying to work on my formulas. 

 

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@Abiola1

Hi and thank you for your help. If I am understanding correctly, the result TRUE will be the duplicate billed items and the result FALSE will essentially be the claims that are billed correctly? 

 

I have added a sample of the data that I am actually working with. 

 

I am in the end result looking for duplicate billing. The "correct" billing provider is EYE KRAZY OPTICAL. I am looking to identify the additional provider's billing for the same member on the same date of service as EYE KRAZY OPTICAL. 

 

I hope I didn't confuse you. I am known to overthink things. 

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@Kay_T1060 

 

Absolutely yes. The result TRUE is the duplicate billed why FALSE is the otherwise. I have opened your workbook and saw many a handful of columns. I need to know which particular column (either column G or I) you're referring to

Abiola1_0-1582817041327.png

 

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@Abiola1 

Hi, 

 

This is wonderful. I am referring to Column G, but I would like to use Column C because I am going by the billing provider versus the provider's name or location. 

 

Thank you again 

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@Kay_T1060 

 

Based on column C, I created a new column and executed the formula as seen in the caption below

Abiola1_0-1582818925458.png

Duplicate Provider Number returned TRUE while unique numbers returned FALSE. 

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@Abiola1 

Hi, 

Thank you very much for your help and helping me find a faster way to complete the task I am doing!

Have a great day!

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Glad to be of help