CurrentBlue Cross Blue Shield - MainePolicy G-16001

Corrected Claims, Reimbursement Policy

Governs reimbursement and submission rules for corrected claims submitted to AMH Health (Blue Cross Blue Shield - Maine) including timely filing, marking requirements, and exceptions for disasters and state/federal mandates. Applies to participating and non-participating professional providers and facilities.

Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicyCorrected Claims, Reimbursement Policy

Policy CodePolicy G-16001

Change TypeDefinition addedtemplate update

Effective DateJul 23, 2021

Next Review Date

Key ActionProviders must mark paper corrected claims 'Corrected Claim' and use the applicable frequency code on electronic corrected claims.

SourceLink

POLICY UPDATE CHANGES

added definition of Corrected Claim.

policy template updated.

12 monthstimely filing limit

mark 'Corrected Claim'paper requirement

use frequency codeelectronic requirement

no batch/bulksubmission type

Corrected Claim Reimbursement Criteria

Corrected claim reimbursement criteria

Rules governing when corrected claims are reimbursed or denied:

Corrected claim received within applicable timely filing requirements (standard: 12 months from date of service for participating and nonparticipating providers and facilities).

If beyond timely filing limits

Corrected claim filed beyond federal, state-mandated, or company standard timely filing limits will be denied as outside the timely filing limit.
Denied services for failure to meet timely requirements are not subject to reimbursement unless the provider submits documentation proving a corrected claim was filed within the applicable filing limit.

Paper corrected claims must be clearly marked 'Corrected Claim'; electronic corrected claims must include the applicable frequency code (failure to mark or include the code may result in denial as a duplicate).

Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicyCorrected Claims, Reimbursement Policy

Policy CodePolicy G-16001

Change TypeDefinition addedtemplate update

Effective DateJul 23, 2021

Next Review Date

Key ActionProviders must mark paper corrected claims 'Corrected Claim' and use the applicable frequency code on electronic corrected claims.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Submission Requirements and Waivers

Billing Rule

Mark paper 'Corrected Claim' or use frequency code (electronic)

For paper corrected claims, clearly mark the claim "Corrected Claim." For electronic corrected claims, submit using the applicable frequency code. Failure to mark a paper claim or include the frequency code on an electronic claim may result in denial as a duplicate.

Paper submissions: mark "Corrected Claim"
Electronic submissions: use the applicable frequency code

Billing Rule

Submit corrected claims within timely filing (standard 12 months)

Submit corrected claims within the applicable timely filing requirements — standard is 12 months from the date of service for both participating and nonparticipating providers and facilities. Corrected claims filed beyond federal, state, or company timely limits will be denied unless the provider documents a prior filing within the applicable limit.

Standard timely filing limit: 12 months from date of service
Denials for late filing may be overturned only with documentation proving prior timely filing

Denial Risk

Filing requirements may be waived for disasters or state guidance

AMH Health may temporarily waive corrected claim filing requirements following documented natural disasters or under applicable state guidance.

Waiver is temporary and applies only after documented natural disasters or per 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 the original claim omitted charges or contains changed claim information requiring a full replacement submission.

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

Frequency Code

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

Common optionsOriginal Claim; Replacement of Prior Claim (frequency code 7); Void/Cancel Prior Claim (frequency code 8).

Electronic requirementElectronic corrected claims must include the applicable frequency code or they may be denied as duplicates.

Resubmission Period (timely filing)

DefinitionRefers to the initial claim timely filing requirements period that governs when a corrected claim must be submitted.

Standard period12 months from date of service (standard), unless superseded by contract or mandate.

Late submissionsCorrected claims filed beyond federal, state, or company limits will be denied unless documentation proves prior filing within the limit.

OpenPayer

Corrected Claims, Reimbursement Policy

Corrected Claim Reimbursement Criteria

Coding and Timely Filing Limits

Submission Requirements and Waivers

Key Definitions

7	Replacement of Prior Claim (frequency code option)
8	Void/Cancel Prior Claim (frequency code option)