CurrentHighmark Blue Cross Blue Shield WnyPolicy G-16001

Reimbursement Policy Corrected Claims

Governance of reimbursement for corrected claims submissions for Highmark BCBS members in MMC, HARP, Child Health Plus, and Essential Plan programs; affects participating and nonparticipating providers and facilities submitting corrected claims.

Policy Summary

PayerHighmark Blue Cross Blue Shield Wny

PolicyReimbursement Policy Corrected Claims

Policy CodePolicy G-16001

Change TypeRevised / Clarified

Effective Date10/6/2025

Next Review Date

Key ActionSubmit corrected claims within 90 days of the Explanation of Payment; paper claims must be marked 'Corrected Claim' and electronic claims must use the appropriate frequency code (-7 or -8).

SourceLink

POLICY UPDATE CHANGES

Updated to 90-day filing resubmission period and added definition of Corrected Claim.

Updated Definitions section.

90 daystimely filing period (from EOP)

MMC, HARP, CHPlus, EPprograms covered

G-16001policy id

10/06/2025effective

Corrected Claims Reimbursement Criteria

Corrected claim reimbursement criteria

Covered when ALL of the following conditions are met:

ALL of the following

Timely filing: corrected claim is received within 90 days from the Explanation of Payment (EOP) for participating providers and facilities.
applies to participating and nonparticipating providers
Timely filing: corrected claim is received within 90 days from the Explanation of Payment (EOP) for nonparticipating providers and facilities.
applies to participating and nonparticipating providers
Submission format: paper corrected claims must be clearly marked 'Corrected Claim'; electronic corrected claims must include the applicable frequency code (e.g., -7 replacement, -8 void/cancel).

Policy Summary

PayerHighmark Blue Cross Blue Shield Wny

PolicyReimbursement Policy Corrected Claims

Policy CodePolicy G-16001

Change TypeRevised / Clarified

Effective Date10/6/2025

Next Review Date

Key ActionSubmit corrected claims within 90 days of the Explanation of Payment; paper claims must be marked 'Corrected Claim' and electronic claims must use the appropriate frequency code (-7 or -8).

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Coding and Timely Filing

Frequency codes for corrected claimsModifier

-7	Replacement of a Prior Claim
-8	Void/Cancel of Prior Claim

Timely filing limit for corrected claims

Timely filing limit90 days from Explanation of Payment (EOP) for participating and nonparticipating providers and facilities

Applies toCorrected claims for Medicaid Managed Care, HARP, Child Health Plus, and Essential Plan members administered by Highmark BCBS/WNY

Exception/WaiverHealth plan may waive filing requirements temporarily for documented natural disasters or per state guidance

Consequence of late filingCorrected claims filed beyond timely limits will not be approved unless provider submits documentation proving timely filing

Provider Submission Requirements and Waivers

Prior Authorization

Corrected claim submission requirements

Submit corrected claims within the policy's timely filing limits and follow the required submission format: paper claims must be clearly marked 'Corrected Claim' and electronic corrected claims must include the applicable frequency code (-7 or -8). Corrected claims must be submitted separately for each member and episode of care; batch, bulk, or packaged submissions are not accepted.

Paper submissions: clearly mark the claim 'Corrected Claim' (failure to mark may result in non-approval as a duplicate).
Electronic submissions: include the applicable frequency code (-7 for replacement, -8 for void/cancel).
Submit one corrected claim per member and episode of care; no batch/bulk/packaged submissions.

Denial Risk

Timely filing limits, denials, and waiver conditions

Corrected claims submitted after the applicable timely filing limit (90 days from the Explanation of Payment for both participating and nonparticipating providers and facilities) will not be approved unless the provider supplies documentation proving the corrected claim was filed within the filing limit. The health plan may temporarily waive filing requirements for documented natural disasters or per state guidance.

Timely filing limit: 90 days from Explanation of Payment (EOP) for participating and nonparticipating providers and facilities.
Provider burden: must present documentation proving timely filing to have an otherwise late corrected claim considered.
Waivers: plan may waive requirements temporarily for documented natural disasters or per applicable state guidance.

Defined Terms

Corrected Claim

DefinitionThe resubmission of an entire claim as a replacement, due to omitted charges or changed claim information.

Submission scopeCorrected claims must be submitted separately for each member and episode of care; batch/bulk/packaged submissions are not accepted.

Paper claim requirementPaper corrected claims must be clearly marked 'Corrected Claim'.

Frequency Code

PurposeIndicates the claim is a correction of a previously submitted and adjudicated claim; selects how the resubmission should be processed.

-7Replacement of a Prior Claim

-8Void/Cancel of Prior Claim

Electronic submissionCorrected claims submitted electronically must include the applicable frequency code (-7 or -8).