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    v1.0.28
    OpenPayerPolicy UpdatesReimbursement/Payment PolicyAmerigroup corrected claims reimbursement policy |…
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    CurrentAmerigroupPolicy G-16001

    Reimbursement Policy Corrected Claims

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    Defines Amerigroup's rules for reimbursement of corrected claims submitted within applicable timely filing limits and instructions for marking and coding corrected claims; applies to providers submitting claims to Amerigroup for covered members.

    Policy Summary
    PayerAmerigroup
    PolicyReimbursement Policy Corrected Claims
    Policy CodePolicy G-16001
    Change TypeNo material changes
    Effective DateOct 6, 2025
    Last ReviewOct 6, 2025
    Next Review Date
    Key ActionSubmit corrected claim within applicable timely filing limits and mark paper claims 'Corrected Claim' or use frequency code 7 (Replacement) or 8 (Void/Cancel) for electronic submissions.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    3 monthstimely filing window (participating)
    3 monthstimely filing window (nonparticipating)
    1frequency codes specified
    2acceptable frequency code values

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Corrected Claims Reimbursement Criteria

    Corrected claims reimbursement criteria

    Reimbursement is allowed when ALL of the following are met:

    ALL of the following

    • Corrected claim is received within the applicable timely filing requirements of the original claim.

    • Timely filing window

      • Three months from the date of the original claim submission for participating providers and facilities.
      • Three months from the date of the original claim submission for nonparticipating providers and facilities.
    • Corrected claim is marked or coded appropriately: paper resubmissions clearly marked 'Corrected Claim' or electronic submissions include the applicable frequency code.
    • Corrected claims are submitted separately for each member and episode of care (no batch, bulk, or packaged submissions).

    Coding and Timely Filing Limits

    Frequency codes for corrected claimsModifier
    7Replacement of a Prior Claim
    8Void/Cancel of Prior Claim
    Timely filing limit — corrected claims (months)
    Timely filing limit (participating providers)3 months from date of original claim submission
    Timely filing limit (nonparticipating providers)3 months from date of original claim submission
    Requirement when initial claim not cleanCorrected claim must be received within the timely filing limit if the initial claim was not a clean claim
    Consequence of late filingClaims filed beyond federal, state-mandated, or company timely filing limits will not be approved unless documentation proves timely filing

    Submitting Corrected Claims & Consequences

    Billing Rule

    Submitting corrected claims

    Submit corrected claims within the applicable timely filing limits and submit separately for each member and episode of care. For paper resubmissions, clearly mark the claim "Corrected Claim." For electronic submissions, include the applicable frequency code (use 7 for Replacement or 8 for Void/Cancel) so the claim is processed as a correction rather than a duplicate.

    • Paper: mark "Corrected Claim".
    • Electronic: use frequency code 7 (Replacement) or 8 (Void/Cancel).
    • Submit separately per member and episode of care; do not submit corrected claims in batch or bulk.
    Denial Risk

    Timely filing consequences

    Corrected claims submitted after federal, state-mandated, or company timely filing limits will not be approved because they are outside the timely filing limit. Such services are not eligible for reimbursement unless the provider presents documentation proving the corrected claim was filed within the applicable filing limit.

    Documentation Required

    Waiver of filing requirements

    The health plan may temporarily waive corrected claim filing requirements following documented natural disasters or as directed by applicable state guidance.

    Definitions

    Corrected Claim — definition
    DefinitionThe resubmission of an entire claim as a replacement, due to omitted charges or changed claim information.
    When to useSubmit when you need to replace a previously submitted claim with corrected information
    Submission requirementsCorrected claims must be submitted separately for each member and episode of care; paper claims must be marked 'Corrected Claim' and electronic claims must include the applicable frequency code
    Frequency Code — definition and values
    PurposeIndicates the claim is a correction of a previously submitted and adjudicated claim.
    Frequency code 7Replacement of a Prior Claim — used to resubmit an entire claim as a replacement
    Frequency code 8Void/Cancel of Prior Claim — used to void or cancel a previously submitted claim
    Use in submissionsElectronic corrected claims must include the applicable frequency code; paper corrected claims must be marked 'Corrected Claim'
    Policy Summary
    PayerAmerigroup
    PolicyReimbursement Policy Corrected Claims
    Policy CodePolicy G-16001
    Change TypeNo material changes
    Effective DateOct 6, 2025
    Last ReviewOct 6, 2025
    Next Review Date
    Key ActionSubmit corrected claim within applicable timely filing limits and mark paper claims 'Corrected Claim' or use frequency code 7 (Replacement) or 8 (Void/Cancel) for electronic submissions.
    SourceLink
    On This Page
    Corrected Claims Reimbursement CriteriaCoding and Timely Filing LimitsSubmitting Corrected Claims & ConsequencesDefinitions