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Electronic claim resubmission requirements

August 31, 2016

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As a reminder, there are specific guidelines in the Independence Blue Cross 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 in the following Segments are required in Loop 2300:
    • ? REF ? Payer Claim Control Number (REF01 = F8 and Independence Claim Number in REF02)
    • ? NTE ? Billing Note (NTE01 = ADD and detailed description regarding the adjustment in NTE02)

Claims 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

For more information about electronic claim submission guidelines, refer to the Independence Blue Cross HIPAA Transaction Standard Companion Guide, available on the Trading Partner Business Center.

If you have questions about the requirements for resubmitting electronic claims, please contact your Network Coordinator.

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