Electronic Billing of Corrected Medical Claims

April 26, 2012

Every provider and billing company knows that there will always be instances in which it is necessary to file a corrected claim. Perhaps a more appropriate CPT needs to be billed, a modifier appended, or diagnosis revised. In any case, the process of correcting and resubmitting claims can be both time-consuming and frustrating when reimbursement is delayed. If your medical billing team is still submitting corrected claims by paper, then this delay will only be worsened! It used to be thought that corrected claims needed to be sent via paper so that the insurance carriers would not deny the resubmission as a duplicate of the original. Printing and snail-mailing claims increases days in AR, and likewise increases the chance of the claim being lost or reported as not received by the insurance carrier. Meanwhile, submitting electronically not only increases turn-around between resubmission and reimbursement, but also provides a traceable record of claim submission and carrier receipt. Fortunately, most major carriers now have the capacity to accept electronically-submitted corrected claims. Even CareFirst BlueCross BlueShield published in its recent April 25, 2012 Provider Newsletter that all providers who are able to submit electronically should do so for both original and corrected claims.

In order to prevent the electronic resubmission from rejecting as a duplicate by your clearinghouse or insurance carrier, two fields need to be populated in the HIPAA 837P claims transaction. A value of ‘7’ should be listed in Loop 2300, Segment CLM05-3. The ‘7’ is the “claim frequency type code” that indicates that the claim is a replacement of the original. In Loop 2300 (Ref*F8), the original claim # should be listed. (Note: If you were mailing the corrected claim, these two segments correspond to HCFA Box 22a and 22b). Now, while many of us do not know the exact meaning of the various segments and loops of the electronic claim transaction, most Practice Management systems should have readily-available fields where this information can be added to the claim. If you can’t find the appropriate fields, give Healthcare Data Management a call! We constantly strive to find ways of increasing providers’ efficiency and reimbursement speed.