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    v1.0.28
    OpenPayerPolicy UpdatesReimbursement/Payment PolicyEmpire Bluecross Corrected Claims Policy Update | …
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    CurrentEmpire BluecrossPolicy G-16001

    Corrected Claims

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    Governs reimbursement and filing requirements for corrected claims submitted to Anthem Medicare Advantage (Empire Bluecross) for covered services; applies to participating and non-participating providers submitting corrected claims for members.

    Policy Summary
    PayerEmpire Bluecross
    PolicyCorrected Claims
    Policy CodePolicy G-16001
    Change TypeNo material changes
    Effective DateJul 23, 2021
    Last ReviewJul 23, 2021
    Next Review Date
    Key ActionResubmit corrected claim within the 12-month timely filing limit and mark paper claims 'Corrected Claim' or use the appropriate electronic frequency code.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    12 monthsTimely filing limit
    separateSubmission per member/episode
    paper/electronicMarking required
    conditionalWaiver allowed

    Corrected Claims Acceptance Criteria

    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.

    Corrected Claims Criteria

    Covered when ALL of the following criteria are met:

    ALL of the following

    • For participating and non‑participating providers: within 12 months from the date of service

      Standard timely filing limit unless contract specifies otherwise

    ALL of the following

    • Paper claims: clearly marked 'Corrected Claim'

      Failure to mark may result in denial as a duplicate

    • Electronic claims: submitted with the applicable frequency code

      Use appropriate code to indicate correction (e.g., replacement/void as applicable)

    Corrected claims are submitted separately for each member and episode of care

    Batch, bulk, or packaged submissions are not accepted

    Exception - Waiver of filing requirements

    • Documented natural disaster affecting filing
    • Applicable state guidance permitting temporary waiver

    ALL of the following

    • Will be denied as outside the timely filing limit
    • Not subject to reimbursement unless provider presents documentation proving the corrected claim was filed within the applicable filing limit

    Frequency Codes and Timely Filing

    Frequency codesModifier
    0Original claim
    7Replacement of prior claim
    8Void/Cancel prior claim
    Timely filing
    Timely filing period12 months from date of service
    Corrected claim submission requirementsCorrected claims must be clearly marked (paper) or include the applicable frequency code (electronic). Submit separately per member and episode of care; no batch/bulk submissions.
    Late corrected claimsClaims filed beyond federal, state-mandated, or company timely filing limits will be denied unless documentation proves a corrected claim was filed within the applicable filing limit.
    WaiverTimely filing requirements may be waived temporarily for documented natural disasters or per applicable state guidance.

    Actions Providers Must Take for Corrected Claims

    Billing Rule

    Resubmit corrected claim within timely filing and mark as correction

    Resubmit the corrected claim within the applicable timely filing limit — standard is 12 months from the date of service for participating and non‑participating providers. If submitting on paper, clearly mark the claim "Corrected Claim"; if submitting electronically, use the applicable frequency code. Corrected claims must be submitted separately for each member and episode of care and cannot be batched.

    • Timely filing standard: 12 months from date of service for participating and nonparticipating providers.
    • Paper submissions: clearly mark the claim "Corrected Claim."
    • Electronic submissions: include the applicable frequency code to indicate a correction.
    • Submit separately per member and episode of care; batch/bulk/packaged submissions are not accepted.

    Key Definitions

    Frequency Code — corrected claims
    Frequency code purposeIndicates the claim is a correction of a previously submitted and adjudicated claim
    Original claimUse when submitting the initial claim (Original Claim)
    Replacement of Prior ClaimUse when replacing a previously adjudicated claim (Replacement of Prior Claim)
    Void/Cancel Prior ClaimUse to void or cancel a previously adjudicated claim (Void/Cancel Prior Claim)
    Resubmission Period
    Resubmission period definitionRefers to and must comply with the original claim's timely filing requirements (see timely filing threshold: 12 months from date of service)
    Provider actionResubmit corrected claim within the applicable timely filing limit; paper claims must be marked 'Corrected Claim' and electronic must use the appropriate frequency code
    Documentation requirementIf appealed for late filing, provider must present documentation proving corrected claim was filed within the applicable filing limit
    Policy Summary
    PayerEmpire Bluecross
    PolicyCorrected Claims
    Policy CodePolicy G-16001
    Change TypeNo material changes
    Effective DateJul 23, 2021
    Last ReviewJul 23, 2021
    Next Review Date
    Key ActionResubmit corrected claim within the 12-month timely filing limit and mark paper claims 'Corrected Claim' or use the appropriate electronic frequency code.
    SourceLink
    On This Page
    Corrected Claims Acceptance CriteriaFrequency Codes and Timely FilingActions Providers Must Take for Corrected ClaimsKey Definitions