Corrected Claims
A corrected claim is any claim that has a change to
the original claim (e.g., changes or corrections to
charges, procedure or diagnostic codes, dates of service,
member name, etc.) Corrected claims may be submitted
immediately.
Electronic claims
Corrections can be sent to us in an electronic format.
- Indicate in the 2300 loop the CLM 05-3 if the claim
is an original=1, replacement =7, or void or cancel=8.
- Include "corrected claim" in the
narrative record (NSC Record HAO) of the first service
detail line.
Paper claims
To ensure the corrected
claim is routed to the appropriate area for reprocessing,
use the guidelines below:
| Description
of form |
Requirements |
| Corrected paper claim |
Attach a Corrected
Claim Cover Sheet (PDF) to your
corrected paper claim. Include the following:
- Complete all applicable fields on the Corrected
Claim Cover Sheet.
- Attach a copy of the original claim with
the corrections added to the copy
- Indicate the reason(s) for the correction
(corrected charges, diagnosis, patient
information, etc.)
- Include the claim number that needs to
be corrected. The claim number is located
on your payment voucher.
Paper claims resubmitted with changes should
be marked "corrected claim" in
the upper right hand corner or in Field 24
of your CMS-1500 or ADA Dental claim
form. |
| UB-04 paper claim |
Use the Type of Bill code 7 Replacement
of prior claim as the third digit and
indicate the changes in the remarks field. |
Send corrected paper claims to the address on the
back of the member’s card.
Note: To print a PDF document, you need Adobe® Reader®. Download it now for free.
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