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    v1.0.28
    OpenPayerPolicy UpdatesReimbursement/Payment PolicyBlue Cross Blue Shield - Oklahoma corrected claims…
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    CurrentBlue Cross Blue Shield - OklahomaPolicy CPCPO25

    Corrected Claim Submissions

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    Rules and instructions for submitting corrected (replacement/void) claims to Blue Cross Blue Shield - Oklahoma, including electronic and paper procedures, frequency codes, required documentation, and conditions affecting reimbursement and denials. Applies to providers billing BCBSOK for member services.

    Policy Summary
    PayerBlue Cross Blue Shield - Oklahoma
    PolicyCorrected Claim Submissions
    Policy CodePolicy CPCPO25
    Change TypeFrequency code revision
    Effective DateJul 1, 2024
    Last ReviewDec 11, 2023
    Next Review DateN/A
    Key ActionSubmit a corrected claim only after the original claim is processed and include all original accurate line items plus supporting documentation (e.g., medical records, copy of original claim).
    SourceLink
    POLICY UPDATE CHANGES

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

    Code 7Replacement of Prior Claim
    Code 8

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    Void/Cancel of Prior Claim
    No code 5Do not use code 5
    DCN requiredOriginal claim identifier required

    Corrected Claim Acceptance and Processing

    Corrected claim acceptance and processing criteria

    Conditions under which corrected claims are accepted and how they will be processed:

    Corrected claims should be minimal and submitted only when original claim information was incomplete or inaccurate; corrections may not be submitted until the original claim has been processed and the provider notified of claim status.
    Corrected claims must be filed within the plan's timely filing deadlines.
    When submitting a replacement corrected claim, all accurate line items from the original submission must appear on the replacement claim; line items requiring correction should be included alongside the original accurate lines to avoid unintended refund or overpayment requests.
    If reimbursement line items present on the original claim are removed on the corrected claim, reimbursement may be subject to recoupment by the plan.
    An increase in billed charges for line items from the original claim without adequate justification is not considered a corrected claim and may prompt claim review and potential recoupment.
    Late charges or additional charges must be submitted as a corrected claim only after the original claim has been processed.
    For inpatient or outpatient corrected claims that add late/additional charges, resubmit the entire claim (original values and late/additional charges) with frequency code 7 (Replacement of Prior Claim); do not use frequency code 5 for corrected inpatient/outpatient claims as use of code 5 may result in denial.
    Corrected claims may require supporting documentation (e.g., medical records, copy of the original claim) to justify corrections to diagnosis codes, DRGs, procedure codes, medication units, modifiers, or other modifications.
    Corrected claims should be submitted electronically when possible; paper corrected claims must use CMS-1500 (08/05) for professional providers or UB-04 for institutional providers and must include the provider NPI when required.
    Electronic corrected claims must include the original claim number / Document Control Number (DCN) in the appropriate electronic reference field when submitting replacement (frequency code 7) or void/cancel (frequency code 8) claims; failure to reference the original claim may result in rejection or processing delay.
    Corrected claims are subject to plan claim review protocols including plan benefit terms, provider contracts, medical policies, coding edits, and possible requests for additional documentation; overpayments identified by review may still be subject to refund/recoupment if not addressed on the corrected claim.

    Claim Frequency Codes and Timely Filing

    Claim frequency codesmixed
    7Replacement of Prior Claim
    8Void/Cancel of Prior Claim
    5Late Charges (do not use for corrected inpatient/outpatient claims)
    Timely filing — corrected claims must be filed within timely filing deadlines
    Timely filing requirementCorrected claims must be filed within the plan's timely filing deadlines; a correction may not be submitted until the original claim has been processed and the provider has been notified of claim status.
    Minimal submissions advisedSubmit corrected claims only when necessary — the Plan urges providers to submit claims once all charges are documented to reduce processing errors and duplicate filing.
    Include all accurate original line itemsAll accurate line items from the original submission must appear on the replacement claim along with the corrected lines to avoid unintended refund or overpayment requests.
    Supporting documentation may be requiredMedical records, copy of the original claim, or other documentation may be required to justify corrections to diagnosis codes, procedure codes, medication units, modifiers, or other modifications.

    Submitting Corrected Claims — When, How, and Required Documentation

    Documentation Required

    Submit corrected claim only after original processed; include original lines and supporting documentation

    Submit a corrected claim only after the original claim has been processed and the provider has been notified of the claim status. Include all original accurate line items on the replacement claim and provide supporting documentation as needed (for example, medical records or a copy of the original claim) to justify corrections.

    • Do not submit a corrected claim until the original claim is processed and provider notified.
    • Replacement claim must include all accurate line items from the original submission plus corrected lines.
    • Examples of supporting documentation: medical records, copy of the original claim, documentation reflecting repeated procedures.
    Billing Rule

    Key Terms

    Definition of a corrected claim — used to update a previously processed claim; member- and claim-specific; not an appeal
    DefinitionA corrected claim is used to update a previously processed claim with new or additional information; it is member- and claim-specific and does not constitute an appeal.
    When to submitDo not submit a corrected claim until the original claim has been processed and the provider has been notified of the claim status.
    Scope of changesUse corrected claims for updates such as diagnosis code, procedure code, modifier updates, units billed, billed charge updates, date of service corrections, or provider ID corrections (not for unjustified increases in billed charges).
    Submission methodsAll changes must be submitted via electronic or paper claim submissions — not by calling the Plan.
    Identifier required on all corrected claim submissions — original claim number / Document Control Number (DCN)
    Policy Summary
    PayerBlue Cross Blue Shield - Oklahoma
    PolicyCorrected Claim Submissions
    Policy CodePolicy CPCPO25
    Change TypeFrequency code revision
    Effective DateJul 1, 2024
    Last ReviewDec 11, 2023
    Next Review DateN/A
    Key ActionSubmit a corrected claim only after the original claim is processed and include all original accurate line items plus supporting documentation (e.g., medical records, copy of original claim).
    SourceLink
    On This Page
    Corrected Claim Acceptance and ProcessingClaim Frequency Codes and Timely FilingSubmitting Corrected Claims — When, How, and Required DocumentationKey Terms

    Use frequency code 7 to replace and 8 to void; do not use code 5 for late charges

    Use frequency code 7 to replace the prior claim (resubmit the entire claim including original values and include the original DCN) and use frequency code 8 to void/cancel the prior claim. Do not use frequency code 5 for late charges on inpatient/outpatient corrected claims.

    • Frequency code 7 — Replacement of Prior Claim: file the claim in its entirety and include the original claim DCN; plan will adjust the original claim.
    • Frequency code 8 — Void/Cancel of Prior Claim: include original claim identifiers and reason for void in the Remarks field; plan will void the original claim.
    • Do not submit corrected inpatient/outpatient claims using frequency code 5; use code 7 for late/additional charges or risk denial.
    Billing Rule

    Electronic preferred; paper claims require CMS-1500 (08/05) or UB-04 and include NPI and DCN

    Submit corrected claims electronically when possible. If submitting paper claims, professional providers must use Form CMS-1500 (08/05) and institutional providers must use UB-04; paper submissions must include NPI and the original claim number or DCN.

    • Electronic replacement claims with frequency code 7 or 8 must include the original claim number/DCN in Loop 2300 REFO2 with qualifier F8.
    • Paper claims: CMS-1500 (08/05) for professional or UB-04 for institutional; include NPI or paper claims may be denied or returned.
    • All corrected claim submissions must contain the original claim number or Document Control Number.
    Required identifier
    All corrected claim submissions must include the original claim number or the Document Control Number (DCN).
    Electronic submission placementFor electronic replacement claims submitted with frequency code 7 or 8, the original claim number or DCN must be provided in Loop 2300 REFO2 (Payer Claim Control Number) with qualifier F8 in REFO1.
    Failure to include identifierFailure to submit the original claim number or DCN will generate a compliance error and the claim will be rejected.
    Must match original paid claim when voidingWhen using frequency code 8 (void/cancel), required information (patient name/initial, member ID, DCN, claim change reason/condition code and dates of service) must match the original paid claim.