Attention! An update has been made to this page.
Recently, we have seen a large volume of corrected claims that are incomplete due to missing information in the appropriate fields on the CMS-1500 (professional) and UB-04 (facility) claim forms, such as the original reference/claim number.
Please note: The term ?corrected claim? is meant for corrections to claims that were processed in the adjudication system and for which a claim number was assigned, but the provider wishes to have the following performed on the original claim:
- Replacement of prior claim (requesting an adjustment or void/reissue);
- Void/cancel of prior claim (reflecting the elimination of a previous claim in its entirety);
- Late charges were added to an inpatient claim after the original claim was processed.
Please follow the instructions below to ensure your corrected claims are accurately processed in a timely manner.
Paper claims
CMS-1500 claim form
Box 22 ? Resubmission and/or Original Reference Number
Follow the instructions from the National Uniform Coding Committee (NUCC) billing requirements:
- List the original reference number for resubmitted claims.
- When submitting a claim, enter the appropriate resubmission code in the left-hand side of the field.
- – 7 = Replacement of prior claim
- – 8 = Void/cancel of prior claim
Example:
For more information, please refer to the 1500 Health Insurance Claim Form Reference Instruction Manual, which is available under the 1500 Claim Form tab on the NUCC website .
UB-04 claim form
Field location 64 ? Document Control Number
This field is used to capture the original reference/claim number, which is required for corrected claims.
Electronic claims
As a reminder, there are specific guidelines in the AmeriHealth versions of the HIPAA Transaction Standard Companion Guide that providers must follow when resubmitting a claim for an adjustment. In order for the adjustment to occur, the following Loop ID/Reference segments must be populated accordingly:
- Loop ID: 2300, Reference: CLM05-3 (Claim Frequency Type Code);
- If CLM05-3 contains 5, 7, or 8, prior claim information is required. The following segments are required in Loop 2300:
- – REF – Payer Claim Control Number (REF01 = F8 and AmeriHealth Claim Number in REF02)
- – NTE – Billing Note (NTE01 = ADD and detailed description regarding the adjustment in NTE02)
Claim resubmission
Claim Frequency Type Codes that tie to a "prior claim" or "finalized claim" refer to a previous claim that has completed processing in the payer's system and has produced a final paper/electronic Provider Explanation of Benefits (professional) or Provider Remittance (facility).
Please note the following:
- Previous claims that are pending due to a request from the payer for additional information are not considered a "prior claim" or "finalized claim.?
- An 837 professional claim transaction is not an appropriate response to a payer's request for additional information. Rather, providers must follow the instructions within the request for returning the additional information. At this time, there is no EDI transaction available to return the requested information.
For more information about electronic claim submission guidelines, refer to the appropriate HIPAA Transaction Standard Companion Guide for AmeriHealth New Jersey or AmeriHealth Pennsylvania, available on the Trading Partner Business Center.
If you have any questions about corrected claim resubmission requirements, please contact your Provider Partnership Associate or Network Coordinator.