Wiki corrected claims resubmission

[breedlove]

I have a vendor who submits new claims when the original claim denies. For example....a claim denies for a diagnoses billed with 99213 so the vendor submits a new claim (instead of a corrected claim) for 99213 with a different diagnoses. So basically the insurance company will have two office visits on file with different diagnoses. To me it makes more sense to send a corrected claim so that the incorrect diagnoses comes off of the patients record at the insurance company. What are your opinions on this?

 

[csperoni]

I would think the 2nd claim would just deny as a duplicate. A corrected claim should be sent since you are, in fact, correcting the original claim.

 

[thomas7331]

I think it really depends on the payer. I've worked with payers that exclude denied claims from their duplicate logic and these payers prefer that a corrected claim be submitted electronically as a new claim as this is more efficient for processing. Others though will deny a resubmitted claim as a duplicate so you may have no choice but to submit a corrected claim. Certainly if the original claim was paid and you are submitting a correction that will require the original claim to be altered, it's best to submit it as a corrected claim to ensure that the changes are made.