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    v1.0.28
    OpenPayerPolicy UpdatesReimbursement/Payment PolicyBlue Cross Blue Shield Nevada Corrected Claims Pol…
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    CurrentBlue Cross Blue Shield - NevadaPolicy G-16001

    Corrected Claims, Reimbursement Policy

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    Defines Anthem Medicare Advantage reimbursement and timely-filing rules for corrected claims and instructions for providers (participating and non‑participating) submitting corrections.

    Policy Summary
    PayerBlue Cross Blue Shield - Nevada
    PolicyCorrected Claims, Reimbursement Policy
    Policy CodePolicy G-16001
    Change TypeNo material change
    Effective DateJul 23, 2021
    Last ReviewAug 28, 2023
    Next Review Date
    Key ActionSubmit corrected claim within the timely filing limit; mark paper claims 'Corrected Claim' and include the applicable frequency code on electronic submissions.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    12 monthsTimely filing limit
    Must be markedPaper requirement
    Frequency codeElectronic requirement

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    No batch
    Submission constraint

    Corrected Claim Coverage Criteria

    Corrected claim coverage criteria

    Anthem Medicare Advantage reimburses corrected claims when submission requirements are met and the claim is received within the applicable timely filing limits; failure to comply may result in denial, recoupment, or adjustment.

    Corrected claim must be received within the applicable timely filing requirements of the original claim; for providers and facilities the standard is 12 months from the date of service.
    Corrected claim must be submitted separately for each member and episode of care; batch, bulk, or packaged submissions are not accepted.

    ALL of the following

    • Paper corrected claims must be clearly marked 'Corrected Claim'.
    • Electronic corrected claims must include the applicable frequency code.
    Corrected claims filed beyond federal, state-mandated, or company standard timely filing limits will be denied; denials for late filing are not eligible for reimbursement unless the provider presents documentation proving a corrected claim was filed within the applicable limit.

    Waiver

    • Anthem may temporarily waive corrected claim filing requirements following documented natural disasters.
    • Anthem may temporarily waive corrected claim filing requirements under applicable state guidance.

    Coding, Frequency Codes, and Resubmission Period

    Required coding systems and claim indicatorsmixed
    No codes listed
    Resubmission period — timely filing limit guidance
    Standard timely filing limit12 months from date of service for providers and facilities
    Relation to initial claim rulesCorrected claim must be received within the applicable timely filing requirements of the original claim
    Late submissionsCorrected claims filed beyond federal, state‑mandated, or company standard timely filing limits will be denied as outside the timely filing limit
    ExceptionsAnthem may waive corrected claim filing requirements temporarily following documented natural disasters or under applicable state guidance

    Provider Submission Requirements and Exceptions

    Billing Rule

    Corrected Claim Submission Requirements

    Corrected claims must be submitted within the applicable timely filing limit for the original claim. For participating and nonparticipating providers, Anthem Medicare Advantage follows a standard 12-month timely filing period from the date of service for providers and facilities. Providers resubmitting paper claims for corrections must clearly mark the claim "Corrected Claim." Corrected claims submitted electronically must include the applicable frequency code. Failure to mark or code the claim appropriately may result in denial as a duplicate. Corrected claims must be submitted separately for each member and episode of care and cannot be accepted by batch, bulk, or packaged submissions.

    • Timely filing: 12 months from date of service for providers and facilities (participating and nonparticipating).
    • Paper corrected claims must be clearly marked "Corrected Claim".
    • Electronic corrected claims must include the applicable frequency code.
    • Corrected claims must be submitted separately for each member and episode of care — no batch/bulk/packaged submissions.

    Key Definitions

    Corrected Claim — definition
    DefinitionThe resubmission of an entire claim as a replacement; due to omitted charges or changed claim information.
    PurposeUsed when the original claim requires replacement rather than adjustment
    DocumentationProvider should retain evidence supporting why the entire claim was resubmitted
    Frequency Code — definition and options
    DefinitionIndicates the claim is a correction of a previously submitted and adjudicated claim.
    Common optionsOriginal Claim; Replacement of Prior Claim; Void/Cancel Prior Claim
    Electronic submission requirement
    Policy Summary
    PayerBlue Cross Blue Shield - Nevada
    PolicyCorrected Claims, Reimbursement Policy
    Policy CodePolicy G-16001
    Change TypeNo material change
    Effective DateJul 23, 2021
    Last ReviewAug 28, 2023
    Next Review Date
    Key ActionSubmit corrected claim within the timely filing limit; mark paper claims 'Corrected Claim' and include the applicable frequency code on electronic submissions.
    SourceLink
    On This Page
    Corrected Claim Coverage CriteriaCoding, Frequency Codes, and Resubmission PeriodProvider Submission Requirements and ExceptionsKey Definitions
    Note

    Waiver for Disasters / State Guidance

    Anthem Medicare Advantage may temporarily waive corrected claim filing requirements following documented natural disasters or per applicable state guidance. Any waiver is discretionary and typically time-limited; providers should follow payer communications and state directives for details on waived filing windows and required documentation.

    • Waiver applies only when Anthem documents a disaster or when state guidance permits temporary relief.
    • Providers must follow payer communications for waiver scope, duration, and any documentation required to support late filing.
    Corrected claims submitted electronically must include the applicable frequency code to indicate correction
    Resubmission Period — definition
    DefinitionRefers to the initial claim timely filing requirements — corrected claims must meet the same filing window as the original claim
    Standard timeframeAnthem follows the standard of 12 months from the date of service for providers and facilities
    Submission constraintsCorrected claims must be submitted separately for each member and episode of care and cannot be accepted in batch or bulk submissions