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 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 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. 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)

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 Independence Blue Cross HIPAA Transaction Standard Companion Guide, available on the Trading Partner Business Center.

If you have any questions about corrected claim resubmission requirements, please contact your Network Coordinator.