CurrentBlue Cross Blue Shield - TexasPolicy CPCPO25

Corrected Claim Submissions

Rules and procedures for submitting corrected (replacement/void) claims to Blue Cross and Blue Shield of Texas, including acceptable reasons, required documentation, electronic and paper submission instructions, and frequency code usage; applies to contracted providers submitting claims for covered members.

Policy Summary

PayerBlue Cross Blue Shield - Texas

PolicyCorrected Claim Submissions

Policy CodePolicy CPCPO25

Change TypeNo material change

Effective DateJan 8, 2025

Next Review Date

Key ActionSubmit corrected claims (replacement or void) with the original claim number/DCN and required supporting documentation within timely filing limits.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

7use to replace prior claim (replacement)

8use to void/cancel prior claim

Electronic & paperaccepted submission methods

DCN requiredmust include original claim number

Corrected Claim Criteria

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Corrected claim criteria

Acceptable reasons and required content for corrected claims.

Include the original claim number or Document Control Number (DCN) on all corrected submissions.

When using frequency code 7 (Replacement), replace the entire claim — file the claim in its entirety and include all original line items (correct and incorrect) together with the corrected line items to avoid unintended recoupment or overpayment requests.

When voiding/cancelling a claim using frequency code 8, include the reason for void/cancel in the Remarks field and ensure patient/member identifiers and dates of service match the original claim.

Provide supporting documentation for corrections when requested or when diagnosis/procedure changes are made; examples include medical records and a copy of the original claim.

Do not submit late charges using frequency code 5; late charges or additional charges must be submitted as a replacement (frequency code 7) and may be denied if submitted with code 5.

Paper claims must use the appropriate form (CMS-1500 for professional, UB-04 for institutional) and must include the provider NPI; paper claims lacking NPI may be denied.

Corrected claims must be submitted within the Plan's timely filing deadlines and only after the original claim has been processed and the provider has been notified of the claim status.

Electronic corrected claims must use the appropriate ANSI X12 837 claim frequency codes and include the original claim number/DCN in Loop 2300 REF (qualifier F8) when replacing or voiding a prior claim; claims submitted without the appropriate frequency code or without the original claim number/DCN may deny or be treated as duplicates.

Frequency Codes and Timely Filing

Claim frequency codesmixed

7	Replacement of Prior Claim — use to replace entire claim including updates and late charges
8	Void/Cancel of Prior Claim — use to entirely eliminate a previously submitted claim
5	Late Charges — do not use for corrected claims per Plan guidance (may cause denial)

Timely filing

Timely filing requirementCorrected claims must be filed within the Plan's timely filing deadlines and may only be submitted after the original claim has been processed and the provider has been notified of claim status.

Do not submit before original processedA correction to a prior claim may not be submitted until the original claim has been processed and provider notified of the claim status.

Minimize corrected submissionsThe Plan urges providers to submit claims once all charges are documented to reduce processing errors and duplicate corrected claims.

How Providers Must Submit Corrected Claims

Note

Corrected Claim Submission Overview

Corrected claims are used to update a previously processed claim with new or additional information. They are member- and claim-specific and should only be submitted when the original claim information was incomplete or inaccurate. All changes must be submitted via electronic or paper submission — do not call the Plan to submit corrections. A corrected claim is not an appeal.

Billing Rule

Late Charges Handling

Late charges (additional charges submitted after the original bill was created) must be submitted as a corrected claim only after the original claim has been processed. When adding late charges to an inpatient or outpatient claim, resubmit the entire claim (original values plus late/additional charges) and use frequency code 7 (Replacement of Prior Claim). Do NOT submit a corrected claim using frequency code 5 (Late Charges); use of frequency code 5 may result in denial. If a claim review has been performed, only corrected charges identified during the review (unbilled or incorrectly billed) may be submitted on a corrected claim post-review. Providers may still be obligated to refund any overpayment identified by the review if those charges are not removed from the corrected claim.

Resubmit the entire claim including original line items and late charges when adding late charges.
Use frequency code 7 (Replacement of Prior Claim) for replacements; do not use frequency code 5.
If a corrected claim is submitted using frequency code 5 it may be denied.

Billing Rule

Paper Submission Requirements

Paper claim requirements: Professional providers must use Form CMS-1500 (08/05); institutional providers must use Form UB-04. On paper forms, enter the frequency/resubmission code in CMS-1500 box 22 (Resubmission Code) or UB-04 box 4 (Type of Bill) — use 7 to replace/submit a corrected claim or 8 to void/cancel a prior claim. All corrected paper submissions must include the original claim number or Document Control Number (DCN). The Plan requires an NPI on paper claims; claims filed with only the Plan provider number may be denied. Paper claims that are rejected/denied will be returned with a cover letter explaining the reason for return.

CMS-1500 (08/05) for professional claims; UB-04 for institutional claims.
Enter frequency/resubmission code: 7 = Replacement (corrected/replacement claim); 8 = Void/Cancel.
Include the original claim number or DCN on all corrected claim submissions.
Paper claims must include provider NPI; omitting NPI may cause denial.

Key Definitions

Corrected claim

DefinitionCorrected claim: a member- and claim-specific submission used to update a previously processed claim with new or additional information; does not constitute an appeal.

Scope of useUsed to update incomplete or inaccurate original claim information (examples: replace claim, add/remove charges, date of service correction, provider ID correction, diagnosis/procedure/modifier changes).

Required contentInclude original claim number/DCN and all accurate original line items on the replacement claim; provide supporting documentation (e.g., medical records, copy of original claim) when changes affect diagnosis/procedure or billed charges.

Late charges

Definition of late chargesLate charges are additional charges for items/services submitted after the original bill was created and not included in the original bill.

Submission requirementAll late charges must be submitted as a corrected claim after the original claim has been processed; when adding late charges to inpatient or outpatient claims, resubmit the entire claim including original values and late/additional charges.

Frequency code to useUse frequency code 7 (Replacement of Prior Claim) to add late charges; do not use frequency code 5 for late charges as it may result in denial.