CurrentAnthemPolicy G-16001

Reimbursement Policy Corrected Claims

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Defines the health plan's requirements and limits for reimbursement of corrected claims, including timely filing limits, submission markings/codes, and exceptions; applies to participating and nonparticipating providers and facilities covered by the plan.

Policy Summary

PayerAnthem

PolicyReimbursement Policy Corrected Claims

Policy CodePolicy G-16001

Change TypeClarified definitions

Effective DateOct 6, 2025

Last ReviewOct 6, 2025

Next Review Date

Key ActionMark paper corrected claims 'Corrected Claim' and submit electronic corrected claims with the applicable frequency code (-7 or -8).

SourceLink

POLICY UPDATE CHANGES

Updated Definitions section.

12 monthsparticipating timely filing

12 monthsnonparticipating timely filing

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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 TypeClarified definitions

Effective DateOct 6, 2025

Last ReviewOct 6, 2025

Next Review Date

Key ActionMark paper corrected claims 'Corrected Claim' and submit electronic corrected claims with the applicable frequency code (-7 or -8).

SourceLink

POLICY UPDATE CHANGES

Updated Definitions section.

12 monthsparticipating timely filing

12 monthsnonparticipating timely filing

Corrected Claim Reimbursement Criteria

Corrected claim reimbursement criteria

Covered when ALL of the following are met:

ALL of the following

ALL of the following
- Corrected claims are reimbursed when received within the applicable timely filing requirements of the original claim; standard is 12 months from date of service for participating providers and facilities.
- Corrected claims are reimbursed when received within the applicable timely filing requirements of the original claim; standard is 12 months from date of service for nonparticipating providers and facilities.
ALL of the following
- Paper corrected claims must be clearly marked 'Corrected Claim'.
- Electronic corrected claims must include the applicable frequency code; failure to mark or code appropriately may prevent approval as a duplicate.
ALL of the following
- Corrected claims filed beyond federal, state-mandated, or company timely filing limits will not be approved unless the provider presents documentation proving a corrected claim was filed within the applicable filing limit.
ALL of the following
- The health plan may waive corrected claim filing requirements temporarily following documented natural disasters or per applicable state guidance.
ALL of the following
- Corrected claims must be submitted separately for each member and episode of care and cannot be accepted by batch, bulk, or packaged submissions.
ALL of the following
- Standard correct coding applies; use CPT, HCPCS, and/or revenue codes as appropriate and supported in the medical record; improper coding/billing may result in rejection, denial, recovery, or adjustment of reimbursement.

ALL of the following

Policy may be superseded by provider, state, federal, or CMS contracts and requirements; the health plan reserves the right to recoup or recover payments in accordance with policy implementation delays and updates.

Coding and Timely Filing

General coding guidancemixed

No codes listed

Timely filing limit

Timely filing limit12 months from date of service for participating providers and facilities

Timely filing limit (nonparticipating)12 months from date of service for nonparticipating providers and facilities

ApplicabilityApplies unless provider, state, federal, or CMS contracts/requirements indicate otherwise

Late submissionsCorrected claims filed beyond federal, state-mandated, or company timely filing limits will not be approved unless provider documents a corrected claim was filed within the applicable filing limit

Provider Submission Requirements

Billing Rule

Mark corrected claims and use frequency code -7 or -8

Paper corrected claims must be clearly marked 'Corrected Claim.' Electronically submitted corrected claims must include the applicable frequency code: use -7 for Replacement of a Prior Claim or -8 for Void/Cancel of Prior Claim. Failure to mark paper claims or use the proper electronic frequency code may prevent the claim from being approved as a duplicate.

Paper submissions: mark the claim 'Corrected Claim'.
Electronic submissions: include frequency code -7 (Replacement) or -8 (Void/Cancel).

Defined Terms

Corrected Claim

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

When to useUse when omitted charges or changed claim information require replacing the original adjudicated claim.

Submission notePaper corrected claims must be clearly marked 'Corrected Claim'; electronic submissions must include the applicable frequency code.

Frequency Code

-7Replacement of a Prior Claim

-8Void/Cancel of Prior Claim

Purpose