CurrentAnthemPolicy G-16001

Reimbursement Policy Corrected Claims

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Rules for reimbursement of corrected claims submitted to Anthem New York Medicaid, including timely filing limits, submission requirements, and exceptions for disaster or state guidance; applies to participating and nonparticipating providers and facilities submitting corrected claims in NY Medicaid.

Policy Summary

PayerAnthem

PolicyReimbursement Policy Corrected Claims

Policy CodePolicy G-16001

Change TypeDefinitions updated (non-material)

Effective DateOct 6, 2025

Last ReviewOct 6, 2025

Next Review Date

Key ActionMark paper corrected claims 'Corrected Claim' or use frequency code -7 or -8 for electronic submissions and submit within 60 days of the EOP.

SourceLink

POLICY UPDATE CHANGES

Definitions section was updated.

60 daystimely filing limit (participating)

60 daystimely filing limit (nonparticipating)

1separate submission required

2frequency codes

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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 (non-material)

Effective DateOct 6, 2025

Last ReviewOct 6, 2025

Next Review Date

Key ActionMark paper corrected claims 'Corrected Claim' or use frequency code -7 or -8 for electronic submissions and submit within 60 days of the EOP.

SourceLink

POLICY UPDATE CHANGES

Definitions section was updated.

60 daystimely filing limit (participating)

60 daystimely filing limit (nonparticipating)

1separate submission required

2frequency codes

Corrected Claims Reimbursement Criteria

Corrected claims reimbursement criteria

Conditions under which corrected claims are reimbursed or denied.

Corrected claims will be reimbursed when received within the applicable timely filing requirements of the original claim; standard is 60 days from Explanation of Payment (EOP) for participating and nonparticipating providers and facilities.

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

Paper corrected claims must be clearly marked 'Corrected Claim'; electronic corrected claims must use the applicable frequency code (e.g., -7 for replacement, -8 for void/cancel). Failure to mark or code appropriately may result in the claim not being approved as a duplicate.

Corrected claims filed beyond federal, state-mandated, or company timely filing limits will not be approved unless the provider provides documentation proving the corrected claim was filed within the applicable filing limit; services not approved for failure to meet timely filing requirements are not reimbursable.

Waiver/Exception: The health plan may waive corrected claim filing requirements temporarily following documented natural disasters or per applicable state guidance.

Standard correct coding applies: claims must use CPT, HCPCS, and/or revenue codes and be supported in the medical record; failure to follow appropriate coding/billing guidelines may result in rejection, denial, recovery/recoupment, or adjustment of payment.

Coding and Timely Filing

Related coding guidancemixed

No codes listed

Timely filing limit for corrected claims

Timely filing limit60 days from Explanation of Payment (EOP) for participating providers and facilities

Timely filing limit (nonparticipating)60 days from Explanation of Payment (EOP) for nonparticipating providers and facilities

Action requiredCorrected claims must be received within the 60-day EOP timely filing limit or they will not be approved unless documentation proves timely filing

Submission formatCorrected claims must be submitted separately for each member and episode of care; batch/bulk submissions are not accepted

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

Submission and Provider Requirements

Billing Rule

Corrected claim submission requirements

Paper corrected claims must be clearly marked 'Corrected Claim' or, for electronic submissions, use the applicable frequency code (-7 for replacement or -8 for void/cancel). Corrected claims must be received within the applicable timely filing limits (60 days from the Explanation of Payment for both participating and nonparticipating providers) and must be submitted separately for each member and episode of care; batch or bulk submissions are not accepted.

Mark paper corrected claims 'Corrected Claim'.
Use frequency code -7 (Replacement) or -8 (Void/Cancel) for electronic corrected claims.
Corrected claims must be received within 60 days from the Explanation of Payment (EOP) for participating and nonparticipating providers.
Submit corrected claims separately for each member and episode of care; batch/bulk submissions are not accepted.

Definitions

Corrected Claim

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

What to includeResubmit the entire claim as a replacement rather than submitting partial adjustments; clearly identify it as a corrected claim

Separate submissionsSubmit corrected claim separately per member and episode of care (no batch/bulk submissions)

Frequency Code

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

-7Replacement of a Prior Claim

-8