CurrentAnthemPolicy G-16001

Reimbursement Policy Corrected Claims

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Defines Anthem HealthKeepers' reimbursement rules and timely filing requirements for corrected claims for providers participating in Virginia Medicaid products. Applies to claim resubmissions, required coding/frequency codes, and exceptions (e.g., disaster or state guidance).

Policy Summary

PayerAnthem

PolicyReimbursement Policy Corrected Claims

Policy CodePolicy G-16001

Change TypeDefinitions clarified

Effective DateOct 6, 2025

Last ReviewOct 6, 2025

Next Review Date

Key ActionMark paper resubmissions 'Corrected Claim' or use electronic frequency code -7 (Replacement) or -8 (Void/Cancel).

SourceLink

POLICY UPDATE CHANGES

Updated Definitions section.

12 monthstimely filing limit

Separate per membersubmission format

-7/-8frequency codes

VAapplicability

Corrected Claims Coverage Criteria

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CurrentAnthemPolicy G-16001

Reimbursement Policy Corrected Claims

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Policy Summary

PayerAnthem

PolicyReimbursement Policy Corrected Claims

Policy CodePolicy G-16001

Change TypeDefinitions clarified

Effective DateOct 6, 2025

Last ReviewOct 6, 2025

Next Review Date

Key ActionMark paper resubmissions 'Corrected Claim' or use electronic frequency code -7 (Replacement) or -8 (Void/Cancel).

SourceLink

POLICY UPDATE CHANGES

Updated Definitions section.

12 monthstimely filing limit

Separate per membersubmission format

-7/-8frequency codes

VAapplicability

Corrected Claims Coverage Criteria

Corrected Claims criteria

Corrected claims are reimbursable when submitted correctly and within timely filing requirements; specific requirements follow.

Corrected claim must be received within the timely filing limit (standard: 12 months from adjudication of the original claim and/or date of the EOP for participating providers and facilities).

Paper corrected claims must be clearly marked 'Corrected Claim'; electronic submissions must include the applicable frequency code (-7 or -8).

Corrected claims filed beyond federal, state-mandated, or company timely filing limits will not be approved unless the provider documents timely filing within the applicable limit.

Corrected claims must be submitted separately for each member and episode of care; batch, bulk, or packaged submissions are not accepted.

Exceptions

Health plan may temporarily waive corrected claim filing requirements for documented natural disasters or per applicable state guidance.

Standard correct coding and billing guidelines apply; failure to follow coding/billing rules may result in rejection, denial, or recovery of payment.

Coding and Timely Filing

Corrected claim frequency codesModifier

-7	Replacement of a Prior Claim
-8	Void/Cancel of Prior Claim

Corrected claim timely filing window

Timely filing window12 months from the adjudication of the original claim and/or date of the EOP for participating providers and facilities

ScopeApplies to corrected claims when initial claim is not a clean claim; follows provider, state, federal, or CMS contract requirements where applicable

Submission format requirementPaper corrected claims must be clearly marked 'Corrected Claim'; electronic corrected claims must include the applicable frequency code

ExceptionsWaiver of filing requirements may be granted temporarily for documented natural disasters or per applicable state guidance

Separate submission requirementCorrected claims must be submitted separately for each member and episode of care; batch or bulk submissions not accepted

Submitting Corrected Claims / Provider Responsibilities

Billing Rule

How to submit corrected claims (paper and electronic)

When resubmitting a paper corrected claim, clearly mark the claim “Corrected Claim.” For electronic resubmissions, include the appropriate frequency code: -7 (Replacement of a Prior Claim) or -8 (Void/Cancel of Prior Claim). Failure to mark or code the resubmission appropriately may result in the claim not being approved as a corrected/duplicate claim.

Paper: mark “Corrected Claim” visibly on the resubmission
Electronic: use frequency code -7 or -8 to indicate correction

Denial Risk

Timely filing requirement for corrected claims

Corrected claims must be received within the applicable timely filing limits for the original claim — standard: 12 months from adjudication of the original claim and/or date of the EOP for participating providers and facilities. Claims submitted beyond federal, state-mandated, or company timely filing limits will not be approved unless the provider submits documentation proving the corrected claim was filed within the applicable limit. The health plan may temporarily waive filing requirements for documented natural disasters or per state guidance.

Standard timely filing window: 12 months from adjudication and/or EOP
Corrected claims filed after the limit will not be approved unless provider documents timely filing
Waiver: possible for documented natural disasters or applicable state guidance

Key Definitions

Corrected Claim

DefinitionThe resubmission of an entire claim as a replacement, due to omitted charges or changed claim information.

When to useWhen charges were omitted or claim information changed after original submission

Submission requirementPaper resubmissions must be clearly marked 'Corrected Claim'; electronic submissions must use the applicable frequency code

Frequency Code

-7Replacement of a Prior Claim (use to indicate a corrected claim submitted as a replacement)

-8Void/Cancel of Prior Claim (use to indicate a corrected claim that voids or cancels the prior claim)

PurposeIndicates the claim is a correction of a previously submitted and adjudicated claim; required on electronic corrected claim submissions

Policy Summary

PayerAnthem

PolicyReimbursement Policy Corrected Claims

Policy CodePolicy G-16001

Change TypeDefinitions clarified

Effective DateOct 6, 2025

Last ReviewOct 6, 2025

Next Review Date

Key ActionMark paper resubmissions 'Corrected Claim' or use electronic frequency code -7 (Replacement) or -8 (Void/Cancel).

SourceLink

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