CurrentBlue Cross Blue Shield - New MexicoPolicy CPCPO25

Corrected Claim Submissions

Defines requirements and procedures for submitting corrected (replacement/void/late charge) claims to Blue Cross Blue Shield New Mexico and applies to providers submitting claims on behalf of members.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyCorrected Claim Submissions

Policy CodePolicy CPCPO25

Change TypeRevised frequency code guidance

Effective DateJul 1, 2024

Next Review DateN/A

Key ActionSubmit corrected claims electronically (preferred) or on CMS-1500/UB-04 paper with the original claim number/DCN and include all original and corrected line items.

SourceLink

POLICY UPDATE CHANGES

Changes to Claim Frequency Codes effective 07/01/2024.

Frequency code 7Replacement of prior claim (file entire claim)

Frequency code 8Void/Cancel prior claim

Electronic requiredElectronic submission requirement

CMS-1500/UB-04Paper claim forms accepted

Not an appealCorrected claim status

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Corrected Claim Submission Criteria

Corrected claim submission criteria

Covered when ALL of the following requirements are met:

Corrected claim submissions should be minimal; submit corrected claims only after the original claim has been processed and the provider has been notified of claim status (corrections may not be submitted until the original claim is processed).

Corrected claims must be filed within applicable timely‑filing deadlines.

Include the original claim identifier (Document Control Number or original claim number) on all corrected claim submissions. For electronic 837 submissions submit the original claim number/DCN in Loop 2300 REFO2 with qualifier F8. Failure to include the original claim number/DCN will generate a compliance error and may cause rejection.

Use the appropriate claim frequency code: use frequency code 7 to replace (file entire claim including all accurate and corrected line items) and frequency code 8 to void/cancel a prior claim. The plan will only accept code 7 for replacements or code 8 to void a prior claim.

When replacing a prior claim (frequency code 7), file the claim in its entirety including all line items that were previously processed correctly as well as the corrected line items; omission of original accurate line items may result in recoupment.

Late or additional charges (charges submitted after the original billing) must be submitted as a corrected replacement claim after the original claim is processed; resubmit the entire claim using frequency code 7. Do not use frequency code 5 for late charges.

Provide supporting documentation when required to justify corrections (examples include medical records, copy of the original claim, documentation reflecting a repeated procedure, or other records supporting changes to diagnosis codes, DRGs, procedure codes, medication units, modifiers, billed units or billed charges).

Paper corrected claims are acceptable but must include required data (use CMS‑1500 or UB‑04 and include NPI and the original claim number/DCN) and may require submission of a Corrected Claim Review Form when applicable; paper claims missing required data may be denied or returned.

Corrections submitted without the appropriate frequency code or without the original claim number/DCN will be rejected or treated as a duplicate and will not adjust the original claim.

A corrected claim is an administrative update to a previously processed claim to provide new or additional information; it is not an appeal.

Claim Frequency Codes and Timely Filing

Claim frequency codesmixed

7	Replacement of Prior Claim — file entire claim including corrected items
8	Void/Cancel Prior Claim — eliminates previously submitted claim
5	Late Charges — NOT to be used for corrected claims adding late charges (may result in denial)

Timely filing

Timely filing requirementCorrected claims must be filed within the plan's timely deadlines; a correction may not be submitted until the original claim has been processed and the provider notified of the claim status.

Order of submissionDo not submit corrections before the original claim is processed; wait for original adjudication and notification to avoid rejection or improper processing.

Complete replacement ruleWhen replacing a prior claim, include all accurate original line items plus corrected line items on the replacement claim to avoid unintended recoupment.

Submission Requirements and Provider Responsibilities

Documentation Required

Submit corrected claims with original claim number/DCN and full line items

Submit corrected claims electronically (preferred) or on paper using CMS-1500/UB-04. Include the original claim number or Document Control Number (DCN) and list all accurate line items from the original submission along with any corrected line items. For paper submissions, attach the Corrected Claim Review Form when required. Medical records or other supporting documentation may be requested to justify corrections (e.g., diagnosis, DRG, procedure codes, modifiers, units).

Electronic submission preferred; include original claim number/DCN (Loop 2300 REFO2 with qualifier F8 for electronic claims).
Paper claims must use CMS-1500 or UB-04 and include original claim number/DCN; attach Corrected Claim Review Form when required.
Include all original accurate line items plus any corrected line items to avoid unintended recoupment.
Provide supporting documentation (medical records, copy of original claim, documentation of repeated procedure) when requested.

Key Definitions

Corrected claim — definition

DefinitionA corrected claim is a submission used to update a previously processed claim with new or additional information; it is member- and claim-specific and is not an appeal.

When to useSubmit only if the original claim information was incomplete or inaccurate; all changes must be submitted via electronic or paper submissions, not by phone.

Supporting documentationMedical records or other documentation may be required to justify corrections to diagnosis codes, DRGs, procedure codes, modifiers, units, or other modifications.

Document Control Number (DCN)

Required identifier (DCN)All corrected claim submissions must contain the original claim number (Document Control Number); electronic replacement claims must include the DCN in Loop 2300 REFO2 with qualifier F8.

Consequence of omission