CurrentAnthemPolicy G-16001

Reimbursement Policy Corrected Claims

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This policy governs when and how Anthem (Wisconsin) reimburses corrected claims for BadgerCare Plus and Medicaid SSI members and applies to participating and nonparticipating providers and facilities submitting corrected claims within timely filing limits.

Policy Summary

PayerAnthem

PolicyReimbursement Policy Corrected Claims

Policy CodePolicy G-16001

Change TypeDefinitions updated

Effective DateOct 6, 2025

Last ReviewOct 6, 2025

Next Review DateN/A

Key ActionWhen resubmitting a corrected claim, mark paper claims 'Corrected Claim' or use the applicable frequency code (e.g., -7 replacement, -8 void/cancel).

SourceLink

POLICY UPDATE CHANGES

Updated Definitions section.

365 daystimely filing limit from date of service for participating providers

365 daystimely filing limit from date of service for nonparticipating providers

separateseparate submission required

-7/-8codes to indicate a corrected/void claim

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CurrentAnthemPolicy G-16001

Reimbursement Policy Corrected Claims

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Get alerted when Policy G-16001 changes without checking for updates manually.

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Policy Summary

PayerAnthem

PolicyReimbursement Policy Corrected Claims

Policy CodePolicy G-16001

Change TypeDefinitions updated

Effective DateOct 6, 2025

Last ReviewOct 6, 2025

Next Review DateN/A

Key ActionWhen resubmitting a corrected claim, mark paper claims 'Corrected Claim' or use the applicable frequency code (e.g., -7 replacement, -8 void/cancel).

SourceLink

POLICY UPDATE CHANGES

Updated Definitions section.

365 daystimely filing limit from date of service for participating providers

365 daystimely filing limit from date of service for nonparticipating providers

separateseparate submission required

-7/-8codes to indicate a corrected/void claim

Corrected Claims Reimbursement Criteria

Corrected claims reimbursement criteria

Reimbursement for corrected claims is allowed when filing requirements are met and subject to timely filing limits and other contractual or regulatory constraints.

Corrected claim reimbursement is allowed only when the corrected claim is received within the applicable timely filing requirements of the original claim; unless provider, state, federal, or CMS contracts and/or requirements indicate otherwise.

Timely filing limit: corrected claims must be received within 365 days from the date of service for both participating and nonparticipating providers and facilities.

Corrected claims filed beyond federal, state-mandated, or company standard timely filing limits will not be approved and are not reimbursed unless the provider presents documentation proving timely filing.

Submission format requirements: paper corrected claims must be clearly marked 'Corrected Claim'; electronic corrected claims must include the applicable frequency code. Failure to mark or use the correct frequency code may result in the claim not being approved as a duplicate.

Separate submission requirement: corrected claims must be submitted separately for each member and episode of care; batch, bulk, or packaged submissions are not accepted.

Waiver authority: The health plan may temporarily waive corrected claim filing requirements following documented natural disasters or in accordance with applicable state guidance.

Coding and documentation: corrected claims must follow standard correct coding (CPT/HCPCS/revenue codes) and codes must be supported by the medical record; improper coding or billing may result in rejection, denial, recovery, or adjustment of payment.

Coding and Timely Filing

Standard codingmixed

Standard correct coding applies; use CPT, HCPCS, and/or revenue codes supported by documentation.

Timely filing threshold — corrected claims

Timely filing window365 days from the date of service for participating providers and facilities; 365 days from the date of service for nonparticipating providers and facilities

Applies toBoth participating and nonparticipating providers and facilities delivering services to members

Effect of late filingCorrected claims filed beyond federal, state-mandated, or company timely filing limits will not be approved and are not reimbursed unless provider proves timely filing

Waiver possibilityHealth plan may temporarily waive filing requirements following documented natural disasters or per state guidance

Submission granularityCorrected claims must be submitted separately per member and episode of care; batch/bulk/packaged submissions not accepted

Corrected Claim Submission Requirements

Billing Rule

Mark corrected paper claims or use the correct electronic frequency code

When resubmitting a corrected claim, providers must clearly mark paper claims with the words "Corrected Claim" or, for electronic submissions, use the applicable frequency code (for example, -7 for replacement or -8 for void/cancel). Corrected claims must be received within the timely filing limit and submitted separately for each member and episode of care; failure to mark or use the correct frequency code may result in the claim not being approved as a duplicate.

Timely filing limit: 365 days from date of service for both participating and nonparticipating providers and facilities.
Use frequency code -7 for Replacement of a Prior Claim or -8 for Void/Cancel of Prior Claim for electronic corrections.
Corrected claims filed beyond federal, state-mandated, or company timely filing limits will not be approved unless provider presents documentation proving timely filing.
Corrected claims must be submitted separately per member and episode of care; batch, bulk, or packaged submissions are not accepted.

Key Definitions

Corrected Claim — definition

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

When usedWhen an original claim omitted charges or contained claim information that requires full replacement submission

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

Frequency Code — corrected/void indicators

PurposeIndicates the claim is a correction of a previously submitted and adjudicated claim

-7 frequency code-7 — Replacement of a Prior Claim