ModifiedConnectiCarePolicy RPC20230037

Corrected Claim Submission

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This policy governs how providers submit corrected claims to ConnectiCare, including eligibility, timely filing, required original claim references, electronic claim indicators, and paper claim form instructions. It applies to ConnectiCare products unless otherwise noted, subject to applicable contracts, benefit documents, mandates, and other reimbursement policies.

Policy Summary

PayerConnectiCare

PolicyCorrected Claim Submission

Policy CodePolicy RPC20230037

Change TypeModified

Effective DateJan 1, 2023

Next Review DateNot specified

Key ActionInclude the original claim number on every corrected claim.

SourceLink

POLICY UPDATE CHANGES

The policy was transferred to an individual ConnectiCare-branded template without changing the policy title or policy number.

The policy clarifies that corrected claims must include the original and valid claim number, and that missing or invalid claim numbers cause the claim to deny and be returned.

The policy clarifies that corrected claims are subject to timely filing requirements and provides an additional filing period beyond the original claim timely filing limit.

The revision history states that the policy criteria are not applicable to Exchange and Medicare Advantage plans.

30 daysInitial processing wait

100 daysAdditional corrected claim filing period

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ModifiedConnectiCarePolicy RPC20230037

Corrected Claim Submission

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Policy Summary

PayerConnectiCare

PolicyCorrected Claim Submission

Policy CodePolicy RPC20230037

Change TypeModified

Effective DateJan 1, 2023

Next Review DateNot specified

Key ActionInclude the original claim number on every corrected claim.

SourceLink

POLICY UPDATE CHANGES

The policy was transferred to an individual ConnectiCare-branded template without changing the policy title or policy number.

The policy clarifies that corrected claims must include the original and valid claim number, and that missing or invalid claim numbers cause the claim to deny and be returned.

The policy clarifies that corrected claims are subject to timely filing requirements and provides an additional filing period beyond the original claim timely filing limit.

The revision history states that the policy criteria are not applicable to Exchange and Medicare Advantage plans.

30 daysInitial processing wait

100 daysAdditional corrected claim filing period

7Replacement claim indicator

8Void or cancel indicator

837P/837IElectronic claim formats

Corrected Claim Eligibility and Requirements

Corrected Claim Eligibility and Submission Requirements

Submit a corrected claim only when the original claim has completed processing and a relevant change is needed. Allow 30 days for initial claim processing or the Explanation of Payment (EOP) before submitting a corrected claim.

ALL of the following

The claim was previously paid, applied to the patient's deductible or copayment, or denied by ConnectiCare; or information on the original submission must be corrected.
A corrected claim replaces a previously submitted claim and must include accurate information that could affect claim processing.
The corrected claim includes the original claim number.
Find the original claim number in the provider portal or on the applicable EOP or Electronic Remittance Advice (ERA) available through the provider portal. Missing or invalid original claim numbers cause the corrected claim to deny and be returned.
All services to be considered for payment are included, including services that may already have paid on the original claim submission.
All services for a particular date of service are filed on the same claim form.
For multiple-page paper claims, pages are numbered (for example, Page 1 of 3, Page 2 of 3), and the total charge is entered only on the last page.
Do not enter total charges for all services on each claim form page.
The claim is marked corrected only when information on the original claim submission is changed.
Do not mark a claim corrected when only additional information, such as medical records or a primary carrier EOB, has been requested.
The corrected claim is submitted within the applicable corrected-claim timely filing requirement.original timely filing limit + 100 days
ConnectiCare allows 100 additional days from its original claim submission timely filing limit. For example, if the timely filing limit is 120 days, the corrected claim must be submitted within 220 days from the date of service. Claims filed beyond the limit are denied as outside the timely filing limit; reimbursement requires documentation proving timely filing.

Member ID and Date-of-Service Corrections

When correcting the member ID number or date of service on a processed claim, use both a cancellation of the original claim and a new claim with the corrected information.

ALL of the following

Submit a corrected claim canceling the charges for the original claim.
Submit a new claim with the correct member ID number or date of service.

Electronic and Paper Claim Indicators

Use the applicable electronic or paper claim indicator to identify a replacement or void, and include the original claim number in the designated claim-information field.

Apply the applicable workflow requirements

Electronic claims
- For corrected professional 837P claims, in the 2300 Loop CLM segment, CLM*05-03 (claim frequency type code) is 7 for replacement of a prior claim or 8 for void or cancellation of a prior claim.
- For corrected institutional 837I claims, in the 2300 Loop CLM segment, CLM*05-03 uses the bill type frequency code 0XX7 for replacement of a prior claim or 0XX8 for void or cancellation of a prior claim.
- In the 2300 Loop, include the original claim number in the REF*F8* segment (Claim Information). The original claim number can be found on the remittance advice.
Paper claims

Corrected Claim Coding and Filing Limits

Professional electronic claim frequency codesmixed

7	Replacement of prior claim for corrected professional 837P claim
8	Void or cancel a prior claim for corrected professional 837P claim

Institutional electronic bill type frequency codesmixed

0XX7	Replacement of prior claim for corrected institutional 837I claim, using the applicable bill type digits
0XX8	Void or cancel a prior claim for corrected institutional 837I claim, using the applicable bill type digits

CMS-1500 corrected claim indicatorsmixed

7	Replacement/corrected claim indicator in CMS-1500 Box 22 Code field
8	Void or cancel prior claim indicator in CMS-1500 Box 22 Code field

UB-04 Type of Bill indicatorsRevenue

7	Corrected claim as the third digit of UB-04 Box 4 Type of Bill
5	Late charges as the third digit of UB-04 Box 4 Type of Bill
8	Void or cancel a prior claim as the third digit of UB-04 Box 4 Type of Bill

Original claim referencemixed

Original claim number

Required reference number for the claim being corrected; reported in REF*F8 for electronic claims, CMS-1500 Box 22, or UB-04 Box 64

Initial Processing Wait

Initial processing wait30 days

When it appliesBefore submitting a corrected claim

Processing milestoneAllow time for initial claim processing and the explanation of payment (EOP)

Corrected Claim Timely Filing

Additional filing period100 days

Applies toCorrected claim submissions

How to Submit a Corrected Claim

Billing Rule

When to Submit a Corrected Claim

Submit a corrected claim only after the original claim has been processed—allow 30 days for initial processing/EOP—or when correcting information on the original submission. A corrected claim may be submitted when the original claim was paid, applied to the member’s deductible or copayment, or denied by the Plan.

Denial Risk

Original Claim Number Required

Include the original, valid claim number on every corrected claim. Missing or invalid claim numbers may cause the corrected claim to deny and be returned.

Find the original claim number in the provider portal or on the applicable EOP/ERA available through the portal.
For electronic claims, enter the original claim number in the 2300 loop, REF*F8* (Claim Information) segment.

Key Terms

Corrected Claim

Claim statusReplaces a previously submitted claim

Required changeIncludes a change in relevant information

Purpose of changeThe change could affect how the claim is processed

Relevant Information

DefinitionInformation that could impact the way a claim is processed

ConditionThe information could affect processing if it were considered

Applies toInformation included in a corrected claim

Policy Summary

PayerConnectiCare

PolicyCorrected Claim Submission

Policy CodePolicy RPC20230037

Change TypeModified

Effective DateJan 1, 2023

Next Review DateNot specified

Key ActionInclude the original claim number on every corrected claim.

SourceLink

On This Page

CMS-1500 professional claims: in Box 22 (Corrected Claim Indicator), enter frequency code 7 in the Code field for replacement or frequency code 8 for void or cancellation, and enter the original claim number in the Original Ref No. field.

UB-04 (CMS 1450) facility claims: in Box 4 (Type of Bill), enter 7 for a corrected claim, 5 for late charges, or 8 for void or cancellation as the third digit; then enter the original claim number in Box 64 (Document Control Number).

Missing or invalid original claim numbers cause the corrected claim to deny and be returned.

Calculation100 days beyond ConnectiCare's original claim submission timely filing limit

Illustrative Total Filing Period

Original timely filing limit120 days

Additional corrected claim period100 days

Illustrative total filing period220 days from the date of service

For UB-04 (CMS-1450) claims, enter the original claim number in Box 64 (Document Control Number). Use Box 4 (Type of Bill) third digit 7 for a corrected claim, 5 for late charges, or 8 to void/cancel a prior claim.

Billing Rule

Multiple-Page Paper Claims

For multiple-page paper claims, number every page and report the total charge only on the final page. Keep all services for a particular date of service together on the same claim form.

Number pages as “Page 1 of 3,” “Page 2 of 3,” and so on.
Do not repeat the total charges for all billed services in the total-charge field on each form; show the claim total only on the last page.

Billing Rule

Information Requests Are Not Corrected Claims

Do not mark a claim as corrected when ConnectiCare is only requesting additional information, such as medical records or the primary carrier EOB. Use corrected status only when information on the original claim submission is changed.

Billing Rule

Include All Services

Include every service being considered for payment on the corrected claim, including services that may already have been paid on the original claim submission.

Billing Rule

Member ID or Date-of-Service Corrections

When correcting the member ID number or date of service on a processed claim, use a separate cancel-and-replace workflow.

Submit a corrected claim that cancels the charges from the original claim.
Submit a new claim containing the correct member ID number or date of service.

Denial Risk

Corrected Claim Timely Filing

ConnectiCare allows reimbursement for a corrected claim received within the applicable corrected-claim timely filing limit. Corrected claims submitted beyond that limit will be denied as outside the timely filing limit.

Providers have 100 additional days beyond ConnectiCare’s original claim timely filing limit to submit a corrected claim.
Example: If the original timely filing limit is 120 days, the corrected claim must be submitted within 220 days from the date of service.

Documentation Required

Timely Filing Documentation

Services denied for failure to meet timely filing requirements are not eligible for reimbursement unless the provider presents documentation proving that the corrected claim was filed within the applicable filing limit.

Retain and submit documentation that demonstrates the corrected claim’s filing date and confirms it was filed within the applicable corrected-claim timely filing period.