Electronic Claims Corrected Claims

A corrected/replacement claim is any claim that has changes or corrections to one of the following:

• Diagnosis code
• Date of service/date span
• Total charges or units billed
• Member/patient or provider
• Originally submitted procedure code
• Modifier on a previously processed claim
• Charge for dates-of-service not previously billed (late charges)

Instructions for Submitting Corrected/Replacement Claims 

Providers should submit a corrected claim electronically using the HIPAA 837 standard claims transaction, and include the following information:

• Frequency Code of ‘7’ in Loop 2300, CLM05-3 segment to indicate a corrected/replacement of a prior claim
• All services from the original claim, including the corrected services
• The initial claim reference number or claim number (in Loop 2300, REF01 must contain “F8” and REF02 must contain the claim number, when known)
• A free-form note (highly recommended) with an explanation for the Corrected/Replacement Claim, in Loop 2300 ‘Claim Note’, as:

For Professional & Dental Claims, segment NTE01 must contain ‘ADD’ and segment NTE02 must contain the note, Example: NTE*ADD*CORRECTED PROCDURE CODE

For Institutional Claims, segment NTE01 must contain ‘UPI’ and segment NTE02 must contain the note, Example: NTE*UPI*CORRECTED LAB CHARGES

More Information and Resources 

• Verify filing guidelines in your provider contract
• If you need help getting started with billing corrected claims, talk to your technical support staff or billing agent
• Contact our EDI team with questions: 800-435-2715 or edi@LifeWiseAC.com 
• For professional and institutional claims, Frequency Codes can be found in the National Uniform Billing Specification Manual, which can be obtained at http://nubc.org/ 
• OneHealthPort Claims Processing Policies & Guidelines 
• Best Practice Recommendations for submitting a Corrected/Replacement Claim electronically