CurrentBlue Cross Blue Shield - MainePolicy G-16001

Corrected Claims, Reimbursement Policy

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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

Last ReviewAug 28, 2023

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 code

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CurrentBlue Cross Blue Shield - MainePolicy G-16001

Corrected Claims, Reimbursement Policy

Customize your policy alerts

Sign up for Blue Cross Blue Shield - Maine Policy G-16001 alerts

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

Monitor payer policy activity

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Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicyCorrected Claims, Reimbursement Policy

Policy CodePolicy G-16001

Change TypeDefinition addedtemplate update

Effective DateJul 23, 2021

Last ReviewAug 28, 2023

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 code

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).

Corrected claims must be submitted separately for each member and episode of care; batch, bulk, or packaged submissions are not accepted and may be rejected.

Exceptions

AMH Health may waive corrected claim filing requirements temporarily following documented natural disasters.
Waivers or alternate filing requirements may apply under applicable state guidance or contractual/federal/CMS requirements.

Corrected claims must be submitted within the same timely filing limit that applies to the original claim unless contract, state, federal, or CMS requirements specify otherwise.

Coding and Timely Filing Limits

Frequency codesmixed

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

Original Claim codemixed

Original Claim

Original Claim (frequency code option)

Timely filing limit for corrected claims

Timely filing limit12 months from date of service (standard)

Applies toParticipating and non‑participating professional providers and facilities

Exception sourcesProvider, state, federal, or CMS contracts and requirements may supersede this limit

Waiver provisionAMH Health may waive filing requirements temporarily following documented natural disasters or per state guidance

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.

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).