Monday, October 10, 2016

Different way of submitting corrected claim

Corrected Claims

A request made from a contracting provider to change a claim, (e.g., changing information on the service line, modifier addition, diagnosis correction, etc.) that has previously processed is considered a corrected claim. The submission of a corrected claim must be received by BCBSKS within the 15-month timely filing deadline. Claims denied requesting additional information (e.g. by letter or adjustment reason code) should never be marked "corrected claim" when resubmitted. Instead, providers should submit a new claim with the requested information.

When a claim denial or adjustment is made as a result of a BCBSKS audit, the provider may not submit a corrected claim to reverse the decision. The provider’s next course of action is to enter into the appeal process.

Tufts Health Plan accepts both electronic and paper corrected claims, in accordance with guidelines of the National Uniform Claim Committee (NUCC), the Medicare Managed Care Manual, and HIPAA EDI standards for Tufts Medicare Preferred HMO claims.

Electronic Submissions

To submit a corrected facility or professional claim electronically:

** Enter the frequency code (third digit of the bill type for institutional claims; separate code for professional claims) in Loop 2300, CLM05-3 as either “7” (corrected claim), “5” (late charges), or “8” (void or cancel a prior claim).

** Enter the last 8 digits of the original claim number in Loop 2300, REF segment with an F8 qualifier. For example, for claim #000123456789, enter REF*F8*23456789.

Note: Provider payment disputes that require additional documentation must be submitted on paper.

Paper Submissions

Disputes (not corrected claims) must include a completed Provider Request for Claim Review Form. Both corrected claims and disputes, however, should be mailed to the address on the form.

For a corrected facility claim:

** On the UB-04 (CMS-1450) form, enter either “7” (corrected claim), “5” (late charges), or “8” (void or cancel a prior claim) as the third digit in Box 4 (Type of Bill), and enter the original claim number in Box 64 (Document Control Number).

For a corrected professional claim:

** In Box 22 (Medicaid Resubmission Code) on the CMS-1500 form, enter the frequency code “7” under “Code” and the original claim number in the same box under “Original Ref No.”


The contracting provider shall have the right to a retrospective review of any claim denied in whole or in part. The purpose of a retrospective review is to allow the provider to contact customer service to determine whether the original adjudication was correct.

A. All requests for retrospective review must be submitted (in writing or by phone) to and received by BCBSKS Customer Service within 120 days from the date of the remittance advice.

B. The provider will be given a response to the request for a retrospective review as soon as possible, but no later than 60 days from receipt date. In cases where claims are adjusted, the remittance advice will serve as the response.

Resubmit corrected claims electronically to BCBSTX

 Payer ID 66001

  CLM05-3 segment should indicate claims is a voided/corrected claim

Mail corrected claims to mailing address:

Blue Cross and Blue Shield of Texas

PO Box 51422

Amarillo, TX 79159-1422

Corrected Claims

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