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Re-Submitting Claims

  1. Default Re-Submitting Claims
    Medical Coding Books

    I hope that someone can assist me with a question. What items on a claim should you be abel to change and still re-submit the claim.

    For example, should you be able to change the primary dx, renering provider, add modifiers.

    What items have to remain the same as the first claim submitted and what items can be modfied?

    Thanks for your help.

  2. Default
    I could be mistaken, but I believe this would depend mostly on the type of billing software you are using. Otherwise, I think you can change any information as long as you specify "corrective claim" to indicate to the insurance carrier that information has been changed.

    Does anyone else have more information or documentation on this?

    Hope this helps!
    Tracey Thompson, CPC, CPPM

  3. Default Thanks....what about a claim number...
    Thanks Tracey,

    So If I place corrected claim in Box 19, do I need to add a claim number or some sort of control number to reference the original claim?

    Or should the corrected claim be the same claim number?

    Thanks again for your help!

  4. Default
    You can reference the original claim. However, it should not be necessary.

    When the insurance carrier receives the corrected claim, Box 19 will direct them that this is not the original and that the original needs to be referenced.

    Referencing the original claim really depends on your preferences as well as the carrier preferences. Check with each individual carrier to determine the specifics of handling corrected claims.
    Tracey Thompson, CPC, CPPM

  5. #5
    In just my experience, BCBS wants it noted with the original claim # & all lines refiled. I used to just refile the corrected line of the claim. I began getting BCBS refund requests, their explaination when I called was that they thought because I didn't include all lines then that must have been part of the correction (to remove them!)
    UHC would usually dupe deny my corrected claims, until I started marking the original claim# & filing them via paper, instead of electronically.
    Again, just my experience...others might disagree or have better info...

  6. Default
    I agree with hopepg, definitely include all of the original information as well as the corrected information. This provides the payor with all of the consolidated correct information.

    Again, it may be a good idea to contact each insurance (or at least the major ones you deal with) to get directives of how to handle corrective claims. I would take this information and create a "cheat sheet" to use for future reference.

    A lot of times, sending a corrective claim (even when done correctly by payor preferences) will result in denials or confusion. In my experience, the best way to handle this is simply call the insurance company. This will give you the opportunity to explain the entire situation and be assured that it is being handled correctly in a timely manner.
    Tracey Thompson, CPC, CPPM

  7. #7
    Toledo, Ohio
    I know that there are a lot of insurance companies that I deal with that will not take "corrected claims" they want "adjustment forms" filled out and even then one wants a new claim to go with it. Check to see how your payors want the corrections to come back.

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