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    v1.0.31
    OpenPayerPolicy UpdatesReimbursement/Payment PolicyHealthy Blue LA Corrected Claims Update | OpenPaye…
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    CurrentHealthy Blue LouisianaPolicy G-16001

    Reimbursement Policy Corrected Claims

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    This policy governs when Healthy Blue Louisiana reimburses corrected claims and the submission requirements for corrected claims from participating and nonparticipating providers and facilities.

    Policy Summary
    PayerHealthy Blue Louisiana
    PolicyReimbursement Policy Corrected Claims
    Policy CodePolicy G-16001
    Change TypeAdministrative clarification
    Effective DateOct 6, 2025
    Next Review DateNot specified
    Key ActionSubmit each corrected claim separately for each member and episode of care; batch, bulk, and packaged submissions are not accepted.
    SourceLink
    POLICY UPDATE CHANGES

    The Definitions section was updated to clarify terminology used for corrected claims and claim frequency codes.

    The policy includes a definition of corrected claim as a resubmission of an entire claim as a replacement because of omitted charges or changed claim information.

    12 monthsParticipating provider filing limit
    12 monthsNonparticipating provider filing limit
    2Electronic frequency codes
    1 member/episodeSubmission unit
    Policy Summary
    PayerHealthy Blue Louisiana
    PolicyReimbursement Policy Corrected Claims
    Policy CodePolicy G-16001
    Change TypeAdministrative clarification
    Effective DateOct 6, 2025
    Next Review DateNot specified
    Key ActionSubmit each corrected claim separately for each member and episode of care; batch, bulk, and packaged submissions are not accepted.
    SourceLink
    On This Page
    Corrected Claim Reimbursement CriteriaCorrected Claim Coding and Filing LimitsCorrected Claim Submission RequirementsCorrected Claim Terminology

    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.

    Not acceptedBatch submissions

    Corrected Claim Reimbursement Criteria

    Corrected Claim Reimbursement and Submission Criteria

    A corrected claim is eligible for reimbursement when all applicable filing, identification, and submission requirements are met. The health plan may apply provider, state, federal, CMS, or company requirements that differ from these standards.

    ALL of the following

    • The initial claim was not considered a clean claim and the corrected claim is received within the applicable timely filing limit for the original claim.

      The standard timely filing limit is 12 months from the date of service for both participating and nonparticipating providers and facilities. Provider, state, federal, CMS, or company contracts and requirements may establish otherwise.

    • The claim is submitted using the applicable correction identifier

      • For a paper claim, the claim is clearly marked Corrected Claim.
      • For an electronic claim, the applicable frequency code is included.
    • The corrected claim is submitted separately for each member and each episode of care.

      Corrected claims cannot be accepted through batch, bulk, or packaged submissions.

    A corrected claim filed beyond federal, state-mandated, or company-standard timely filing limits is not approved because it is outside the applicable timely filing limit.

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

    The health plan may temporarily waive corrected claim filing requirements following a documented natural disaster or in accordance with applicable state guidance.

    Corrected Claim Coding and Filing Limits

    Corrected-claim frequency codesmixed
    -7Replacement of a prior claim
    -8Void or cancel of a prior claim
    Corrected-claim timely filing limit
    Participating providers and facilities12 months from date of service
    Corrected-claim timely filing limit
    Nonparticipating providers and facilities12 months from date of service

    Corrected Claim Submission Requirements

    Billing Rule

    Meet the corrected-claim timely filing limit

    Submit the corrected claim within the applicable timely filing limit for the original claim, unless provider, state, federal, or CMS contracts and/or requirements indicate otherwise. The standard limit is 12 months from the date of service for participating and nonparticipating providers and facilities.

    Billing Rule

    Identify the claim as corrected

    Clearly identify the submission as a corrected claim. Paper claims must be marked “Corrected Claim,” while electronic corrected claims must include the applicable frequency code; failure to identify the claim appropriately may result in it not being approved as a duplicate.

    • Paper claims: clearly mark “Corrected Claim.”
    • Electronic claims: include the applicable frequency code.

    Corrected Claim Terminology

    Definitions
    Corrected ClaimThe resubmission of an entire claim as a replacement, due to omitted charges or changed claim information.
    Definitions
    Frequency CodeIndicates the claim is a correction of a previously submitted and adjudicated claim.
    Billing Rule

    Submit corrected claims separately

    Submit a separate corrected claim for each member and episode of care. Batch, bulk, and packaged corrected-claim submissions are not accepted.

    • One corrected claim per member.
    • One corrected claim per episode of care.
    Documentation Required

    Keep proof of timely filing

    Maintain documentation proving that the corrected claim was filed within the applicable filing limit. Claims filed beyond federal, state-mandated, or company standard timely filing limits are not approved or reimbursed unless the provider presents proof of timely filing.