Understanding Box 22 Resubmission Codes on CMS 1500 Claims


Understanding Box 22 Resubmission Codes on CMS 1500 Claims


When it comes to medical billing and claims submission, understanding the various codes and fields on the CMS 1500 form is crucial. In this comprehensive guide, we will focus on Box 22 and its resubmission codes. Box 22 plays a vital role in indicating the original reference number for resubmitted or corrected claims. We will explore the different resubmission codes associated with Box 22, their purposes, and provide insights into related topics such as the ICN number in medical billing. So let's dive in!

find more πŸ‘‰πŸ‘‰ Mastering Box 22 and Original Reference Number-CMS 1500 

What is Box 22 on the CMS 1500 Form?


The CMS 1500 form, also known as the Health Insurance Claim Form, is used for submitting claims for healthcare services rendered. Box 22, labeled "Resubmission Code/Original Ref. No.," is specifically designated for indicating the original reference number associated with resubmitted or corrected claims [1]


Corrected Claims via Box 22


Understanding Resubmission Codes


Resubmission codes play a crucial role in communicating the nature of the claim being submitted. The following resubmission codes are applicable in Box 22 on the CMS 1500 form:


Resubmission Code 6 - Corrected Claim


Resubmission Code 6 is used to indicate a corrected claim. When a claim requires modification or correction due to errors or missing information, the corrected claim is submitted using this code [1]

Resubmission Code 7 - Replacement of Prior Claim


Resubmission Code 7 is utilized when a claim is being submitted to replace a previously submitted claim. This code is used when there is a need to revise a claim due to changes in diagnosis, procedures, or other relevant information [1]

πŸ‘‡πŸ‘‡learn more about Resubmission Code 7πŸ‘‡πŸ‘‡

Navigating Resubmission Code 7: A Comprehensive Guide


Resubmission Code 8 - Void/Cancel Prior Claim


Resubmission Code 8 is employed when a claim needs to be voided or canceled. It indicates that a previously submitted claim should no longer be considered valid or processed. This code is typically used when errors or inaccuracies are identified in a claim that has already been submitted [1]


The Importance of the Original Reference Number (ICN)


The Original Reference Number, also known as the Claim Reference Number or ICN (Internal Control Number), is a unique identifier assigned to a claim or encounter by the destination payer or receiver. It is used to refer to a previously submitted claim or encounter when resubmitting or correcting claims. The ICN should not be used for original claim submissions. It plays a vital role in maintaining the continuity of information and facilitating efficient claims processing [1]


Locating the ICN Number on a Claim


The ICN number can be found in Loop 2300, Segment REF02, of the EDI file when REF01 is F8 [1]

Frequently Asked Questions (FAQs)


FAQ 1: What is the purpose of Box 22 on the CMS 1500 form?

Answer: Box 22 is used to indicate the original reference number for resubmitted or corrected claims, providing important information for efficient claims processing [1]

FAQ 2: How do I determine the appropriate resubmission code for my claim?

Answer: The resubmission code depends on the nature of the claim. Use Resubmission Code 6 for corrected claims, Code 7 for replacements of prior claims, and Code 8 for voiding or canceling prior claims [1].


FAQ 3: Where can I find the ICN number on a claim?

Answer: The ICN number is located in Loop 2300, Segment REF02, of the EDI file, specifically when REF01 is F8 [1]

 Conclusion


Understanding Box 22 resubmission codes on the CMS 1500 form is essential for accurate claims processing and successful resubmission or correction of claims. Resubmission codes 6, 7, and 8 are used to indicate corrected claims, replacements of prior claims, and voiding or canceling prior claims, respectively. The ICN number plays a crucial role in maintaining claim continuity. By familiarizing yourself with these codes and concepts, you can ensure smoother billing processes and minimize claim-related issues.


Remember to consult official resources and billing guidelines for specific instructions related to your circumstances.


References:

[1] Box 22 Resubmission Code/Original Ref. No. – Therabill. Retrieved from





http://www.cms1500claimbilling.com/2010/10/cms-box-22-medicaid-resubmission-code.html

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