Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerPolicy UpdatesReimbursement/Payment PolicyBlue Cross Blue Shield - Texas Corrected Claims Po…
    Ask Trek AI about this page
    CurrentBlue Cross Blue Shield - TexasPolicy CPCPO25

    Corrected Claim Submissions

    Customize your policy alerts

    Sign up for Blue Cross Blue Shield - Texas Policy CPCPO25 alerts

    Get alerted when Policy CPCPO25 changes without checking for updates manually.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    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
    Last ReviewDec 24, 2024
    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

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Electronic & paperaccepted submission methods
    DCN requiredmust include original claim number

    Corrected Claim Criteria

    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
    7Replacement of Prior Claim — use to replace entire claim including updates and late charges
    8Void/Cancel of Prior Claim — use to entirely eliminate a previously submitted claim
    5Late 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.

    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 requirement
    Policy Summary
    PayerBlue Cross Blue Shield - Texas
    PolicyCorrected Claim Submissions
    Policy CodePolicy CPCPO25
    Change TypeNo material change
    Effective DateJan 8, 2025
    Last ReviewDec 24, 2024
    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
    On This Page
    Corrected Claim CriteriaFrequency Codes and Timely FilingHow Providers Must Submit Corrected ClaimsKey Definitions
    • 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.
    All 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.