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Corrected Claims Submission: The Steps You Need To Know

Date: 10/17/17

There are many reasons you may need to submit a corrected claim, but where do you start? No worries – we’re here to help. Here are the five things you need to know about submitting a corrected claim:

Know the deadline.

All claim requests for corrected claims (and reconsideration and claim disputes) must be received within 90 calendar days from the date the notification of payment or denial was issued. No adjustments can be made after that deadline unless there are qualifying circumstances and appropriate documentation is provided to support the qualifying circumstance. An example of a qualifying circumstances might be a catastrophic event such as a natural disaster.

Know how to submit a corrected claim.

There are three ways to submit a corrected claim:

Know what to include.

Corrected claims must include the original claim number or the Explanation of Payment (EOP). The previous claim number you want corrected must be indicated in Field 64 of the UB-04 and in Field 22 of the HCFA 1500. The appropriate frequency code/resubmission code should also be included in Field 64 of the UB-04 and in Field 22 of the HCFA 1500.

Know what not to do.

Copied, downloaded and/or handwritten HCFA-1500 and UB-04 forms cannot be accepted. Only the original red-and-white HCFA-1500 and UB-04 claims forms are acceptable.

Know how to contact us for help.

If you have questions about how to correct a claim, claim status, payment amounts or denial reasons, call our Provider Services team at 1-866-595-8133. You can also submit and review your claims on our secure provider portal. If you’d like to schedule portal training for your staff, contact your dedicated Provider Consultant or call Provider Services.