CurrentBlue Cross Blue Shield - North CarolinaPolicy G-16001

Corrected Claims, Reimbursement Policy

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This policy governs submission and reimbursement of corrected claims for Blue Cross Blue Shield of North Carolina members and applies to participating and non‑participating professional providers and facilities, subject to provider, state, federal, or CMS contract requirements.

Policy Summary

PayerBlue Cross Blue Shield - North Carolina

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 claims within timely filing limits and mark paper claims 'Corrected Claim' or use the appropriate electronic frequency code.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

365 daystimely filing limit (current)

180 daysprior DOS limit

separate

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CurrentBlue Cross Blue Shield - North CarolinaPolicy G-16001

Corrected Claims, Reimbursement Policy

Customize your policy alerts

Sign up for Blue Cross Blue Shield - North Carolina 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 - North Carolina

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 claims within timely filing limits and mark paper claims 'Corrected Claim' or use the appropriate electronic frequency code.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

365 daystimely filing limit (current)

180 daysprior DOS limit

separate

Corrected Claim Acceptance

Corrected claim acceptance criteria

Acceptance and denial criteria for corrected claims:

Corrected claim is received within the applicable timely filing limit set for the original claim.

Timely filing rules

For dates of service through 06/30/2023: corrected claim received within 180 days from the date of service for outpatient services or date of discharge for inpatient services.
As of 07/01/2023: corrected claim received within 365 calendar days from the date of service for participating and non‑participating providers and facilities.

Paper corrected claims are clearly marked 'Corrected Claim' and electronic corrected claims include the applicable frequency code; failure to mark appropriately 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.

Denial and exceptions

Corrected claims filed beyond federal, state‑mandated, or company standard timely filing limits will be denied as outside the timely filing limit.
Services denied for failure to meet timely filing requirements are not reimbursable unless the provider presents documentation proving a corrected claim was filed within the applicable filing limit.
Blue Cross NC may waive corrected claim filing requirements temporarily following documented natural disasters or under applicable state guidance; Blue Cross NC also waives filing requirements for retroactive encounter denials.

Claim Coding and Timely Filing Limits

Claim frequency codesmixed

1	Original Claim frequency code
7	Replacement of Prior Claim frequency code
8	Void/Cancel Prior Claim frequency code

Corrected claim timely filing threshold (current)

Current timely filing limit365 calendar days from date of service for participating and non‑participating providers and facilities (as of July 1, 2023)

Applies toCorrected claims for services with dates of service on or after July 1, 2023

Effect of late submissionCorrected claims filed after 365 days will be denied as outside the timely filing limit unless an exception applies

Prior DOS timely filing threshold

Prior DOS timely filing limit180 days from date of service for outpatient services or date of discharge for inpatient services (for dates of service through June 30, 2023)

Applies toCorrected claims for services with dates of service through June 30, 2023

How to Submit Corrected Claims

Billing Rule

Corrected claim submission actions

Submit corrected claims within the applicable timely filing limits and ensure corrected paper claims are clearly marked "Corrected Claim". For electronic submissions, use the applicable frequency code (1 = Original Claim; 7 = Replacement of Prior Claim; 8 = Void/Cancel Prior Claim). Corrected claims must be submitted separately for each member and episode of care; failure to mark appropriately may result in denial as a duplicate.

Paper corrected claims: clearly mark "Corrected Claim".
Electronic corrected claims: include the applicable frequency code (1, 7, or 8).
Do not submit corrected claims in batch/bulk/packaged submissions; submit separately per member and episode of care.

Denial Risk

Key Terms

Corrected Claim

DefinitionThe resubmission of an entire claim as a replacement due to omitted charges or changed claim information; indicates the claim is a correction of a previously submitted claim.

Submission requirementsMust be submitted separately for each member and episode of care; batch, bulk, or packaged submissions are not accepted.

Marking/encodingPaper claims must be clearly marked 'Corrected Claim'; electronic claims must include the applicable frequency code to avoid duplicate denials.

Frequency Code

Code 1Original Claim frequency code

Code 7Replacement of Prior Claim frequency code