Corrected claims - How do you do a corrected claim - How do you do a corrected claim

brown1106

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How do you do a corrected claim in the following scenario?
Submitted a claim with a drug screening code 80101 and an allergy screening code 83516.
Insurance bundled the two codes and paid for the cheaper of the two. I need to resubmit to get paid for the other code but doing it electronically, it says I can't because we have already been paid for the line I am needing to delete.
Any ideas?
 

btadlock1

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Add a 59 modifier to the code that denied, then send a paper claim and write 'Corrected claim' at the top. Most payers can't accept corrections electronically, so you'll continue to get duplicate denials until you send in a claim marked 'corrected'. Hope that helps! ;)
 

Biller385

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Also, let them know what you are correcting. A cover sheet with the claim nbr, subscribers name and DOB, members name and DOB and what you are correcting would also be helpful.

Cathy
 

btadlock1

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Also, let them know what you are correcting. A cover sheet with the claim nbr, subscribers name and DOB, members name and DOB and what you are correcting would also be helpful.

Cathy
You can just write "59 modifier added to XXXXX", right below "Corrected Claim" on the claim form, and that's usually good enough. One thing I forgot to add, though - be sure and include all of the same charges that processed on the original claim, on your corrected claim. Some payers will recoup payment on charges left off of your corrected claim, because they assume that by leaving them off, you billed them in error.
 

mitchellde

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the 5010 transaction should allow to to submit the corrected claim electronic and attach any coverletter or other paperwork electronic. Check with your vendor about the PWK function for the 5010.
 

kvangoor

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You can send it on paper if the payer allows. Most of my payers accept these electronically. You can use box 22 to indicate this on the paper claim. The resubmission code would be a "7" to indicate corrected claim.
 

Kar116

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When I send a corrected claim, I always send out a paper claim. I also write on the top of the claim: CORRECTED CLAIM and REF CLAIM# where the claim originally denied and that usually solves the problem. Good luck!
 
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