Reimbursement Policy Corrected Claims
Governs reimbursement rules and timely filing requirements for corrected claims submitted to Anthem Blue Cross and Blue Shield Medicare Advantage across listed states, affecting participating and nonparticipating providers and facilities.
Updated Definitions section.
Added definition of Corrected Claim.
Corrected Claims Coverage Criteria
Corrected claims approval criteria
Corrected claims will be reimbursed when submitted within the applicable timely filing limits and properly identified; certain exceptions and requirements apply.
ALL of the following
- Timely filing: The corrected claim is received within the applicable timely filing limit of the original claim.
Standard timely filing: 12 months from date of service for participating providers and facilities; 12 months from date of service for nonparticipating providers and facilities; subject to provider, state, federal, or CMS contract variations.
- Identification: Paper resubmissions are clearly marked 'Corrected Claim' and electronic resubmissions use the applicable frequency code (e.g., -7 or -8).
Failure to mark or use the proper frequency code may result in the claim not being approved as a duplicate.
- Submission format: Corrected claims are submitted separately for each member and episode of care; batch, bulk, or packaged submissions are not accepted.
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