CurrentBlue Cross Blue Shield - OklahomaPolicy CPCP025

Corrected Claim Submissions

Defines requirements and procedures for submitting corrected (replacement or voided) claims to Blue Cross Blue Shield - Oklahoma; applies to providers submitting electronic or paper claims for members covered by BCBSOK plans.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyCorrected Claim Submissions

Policy CodePolicy CPCP025

Change TypeNo material change

Effective DateApr 30, 2020

Next Review Date

Key ActionSubmit corrected claims with all original accurate line items plus corrected lines and include supporting documentation when requested.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

5,7,8designated corrected/late/void claim frequency codes described

include original claim numberrequirement for all corrected submissions

CMS-1500 or UB04paper form requirements

not an appealpolicy distinction

Corrected Claim Submission Criteria

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All accurate line items from the original submission must appear on the replacement claim along with corrected lines to avoid unintended refund or overpayment requests.

Provide supporting documentation as needed (e.g., medical records, copy of original claim) to justify corrections to diagnosis, DRG, procedure codes, units, modifiers, or charges.

When submitting late charges to an inpatient or outpatient claim after the original claim has been processed, resubmit the entire claim (original values and late charges) with the appropriate frequency code; submitting only late charges may result in denial.

Paper corrected claims must include the Corrected Claim Review Form (available on the provider tab of the plan website) and use CMS-1500 (08/05) for professional or UB04 for institutional submissions with the resubmission code (7 replacement or 8 void) in the appropriate field.

Electronic corrected or void claims must use claim frequency code 7 (replacement) or 8 (void) and include the original claim number or Document Control Number (DCN) in Loop 2300 REF02 with qualifier F8 in REF01; failure to include the original claim number/DCN will generate a compliance error and the claim will be rejected.

If a claim review has been performed and an overpayment identified, corrected claims do not remove the requirement to refund identified overpayments; overpayment will be calculated based on the review findings.

A corrected claim is a member- and claim-specific submission used to update a previously processed claim when the original information was incomplete or inaccurate; it is not an appeal.

Claim Frequency Codes and Identifiers

Include original claim number or DCN

RequirementRequired on all corrected claim submissions: include the original claim number or Document Control Number (DCN); missing identifier will generate a compliance error and the claim will be rejected.

Where to provideFor electronic replacement claims include the original claim number/DCN in Loop 2300 REF02 (Payer Claim Control Number) with qualifier F8 in REF01.

Why it mattersFailure to include the original claim number or DCN prevents adjustment of the original claim and may result in rejection or denial.

Submission Requirements and Provider Instructions

Billing Rule

Electronic submission frequency code and identifier

Electronic submissions for corrected claims must use the ANSI X12 837 claim frequency codes and include the original claim number or Document Control Number (DCN). Use claim frequency code 7 for a replacement (corrected) claim or 8 to void/cancel a prior claim. When filing electronically, place the original claim number or DCN in Loop 2300 REF02 with qualifier F8 in REF01. Failure to include the appropriate frequency code or the original claim number/DCN will generate a compliance error, cause the claim to be rejected, or result in denial and the original claim will not be adjusted.

Use claim frequency code 7 = Replacement of Prior Claim (submit entire corrected claim including all original accurate line items and corrected lines).
Use claim frequency code 8 = Void/Cancel of Prior Claim (include all charges from the original claim).
Include original claim number or DCN in Loop 2300 REF02 with qualifier F8 in REF01 for electronic 837 submissions.
All corrected claim submissions should contain the original claim number or DCN; omission will cause rejection or denial.

Billing Rule

Paper claim submission rules

When submitting paper corrected claims, professional providers must use Form CMS-1500 (08/05) and institutional providers must use Form UB04. Enter the appropriate resubmission/frequency indicator: on CMS-1500 use Box 22 (Resubmission Code) and on UB04 use Box 4 (Type of Bill). Use a resubmission/frequency code of 7 for a replacement (corrected) claim or 8 to void/cancel a prior claim. All paper corrected claim submissions must include the original claim number or DCN. Paper claims must include the provider NPI; claims filed with only the plan provider number may be denied or returned.

CMS-1500 (08/05) — enter Resubmission Code in Box 22; use code 7 (replacement) or 8 (void).
UB04 — enter Type of Bill in Box 4; ensure the frequency/type indicates replacement (7) or void (8).
Include the original claim number or Document Control Number (DCN) on the paper corrected claim.
Paper claims may be denied or returned if missing the required NPI or other required information.

Key Definitions

Definition of Corrected Claim

DefinitionA corrected claim is a member- and claim-specific submission used to update a previously processed claim when the original claim information was incomplete or inaccurate; it is not an appeal.

When to useSubmit only when original claim information is incorrect or incomplete; corrected submissions should be minimal and include all accurate original line items plus corrected lines.

DocumentationMedical records or other supporting documentation may be required to justify corrections to diagnosis, DRG, procedure codes, units, modifiers, or charges.

Claim frequency code (ANSI X12 837)

Field meaningClaim frequency code (ANSI X12 837) indicates the type of claim submission (e.g., late charges, replacement, void).

Required usage for corrected claimsElectronic corrected submissions must use frequency code 7 for replacement or 8 for void and must include the original claim number or DCN in REF02 with qualifier F8 in REF01.

Late charges noteFrequency code 5 is used for late charges (institutional only); file electronically and include only the additional late charges not on the original claim.