Wiki Untimely Corrected Claim / Corrected Claim requirements

[cortneyfigurell]

Scenario:
A patient delivered and her chart was audited. Going back to the patients New OB appointment to establish the pregnancy, an error was found with the coding on this claim. This claim will now be 9 months old.
I submitted a corrected claim to fix this issue, only to have this corrected claim deny for timely filing. I called and spoke with a rep and she said their time limit on corrected claims is 180 days from the date of service. Since this patient was pregnant, the problem wasnt resolved until 9 months later due to the patient being pregnant. I cannot find much information on specific payers websites so im not sure where to go from here.

What are the requirements for submitting the corrected claim to fix the error? Do we HAVE to submit a corrected claim? Is there an exclusion when the patient is pregnant?

Is this something i just have to appeal and how do i appeal a timely denial when the original claim was submitted within the time limit?


Thanks,
Cortney!

 

[Chelle-Lynn]

Does the correction that was made affect your payment?

 

[cortneyfigurell]

Yes, but by getting reimbursed less than originally paid. We reported a New patient code and i corrected it to an established E/M

 

[Chelle-Lynn]

If you have attempted to send a corrected claim and it was denied for timeliness, depending on your contract you have two options:

• If you know the difference in payment from the New to Est code based on your contract you can submit a check to the carrier for the difference along with a copy of the corrected claim that denied for timeliness and the reason for the partial refund.

• If you do not know the payment difference, then you can appeal to the carrier advising that a reduction in payment in needed. Often times based on this documentation that less money is owed they will override the timeliness edit and process for the lower rate.

 

[haraml7]

corrected claim

I would call the carrier and tell them the original claim was incorrect, let them process an overpayment letter and then you have the right to correct the claim because there was an error. if they deny for timely you supply them with the overpayment letter showing the date of the correspondence and you were correcting the claim. However, Cigna will NOT reprocess a claim until they receive their overpayment.