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    v1.0.28
    OpenPayerPolicy UpdatesReimbursement/Payment PolicyMolina Healthcare corrected claims policy update |…
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    CurrentMolina HealthcarePolicy N/A

    Reimbursement Policy for Corrected Claims

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    Governs submission, coding, and timing rules for corrected (adjustment/replacement/void) claims to Molina Healthcare; applies to providers submitting claims to Molina plans.

    Policy Summary
    PayerMolina Healthcare
    PolicyReimbursement Policy for Corrected Claims
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective DateSep 1, 2023
    Last ReviewSep 1, 2023
    Next Review DateN/A
    Key ActionSubmit corrected claims as replacement (frequency code 7) or void (frequency code 8) and reference the original Molina claim number/ICN with appropriate frequency/resubmission codes.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    Paper/EDIsubmission methods accepted for corrected claims
    xx7/xx8bill types used for adjustments/voids
    CLM05-3, REF=F8key 837 fields for adjustment claims
    Varies by statetimely-filing limits

    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 Claim Processing Criteria

    Corrected claim processing criteria

    Corrected claims are accepted and processed when they meet all of the following rules:

    ALL of the following

    • ALL of the following

      • Corrected claims may be submitted on paper (standard red UB-04 or CMS-1500) free of handwritten/stamped content or electronically via EDI/Provider Portal.

    • ALL of the following

      • Corrected claims must reference the original Molina claim number or provider control number (UB-04 FL64 / CMS-1500 FL22; 837 REF=F8).

    • ALL of the following

      • Include appropriate frequency/resubmission code per form/837 guidance: use bill type 3rd digit = 7 for Adjustment (replacement) or 8 for Reversal/Void; CLM05-3 must reflect xx7 or xx8 for adjustments/voids; NUCC/UB frequency codes apply (1=Original, 7=Replacement, 8=Void/Cancel).

    • ALL of the following

      • Adjustments and voids apply only to previously paid claims (including zero-paid claims). Resubmitting a denied claim is not an adjustment and should not use adjustment/void bill types.

    • ALL of the following

      • Corrected claims must be submitted within federal, state-mandated, or company-defined timely filing limits; corrected claims submitted after those limits will be denied unless the provider documents timely submission within the filing deadline.

    • ALL of the following

      • Claims lacking the correct coding to indicate replacement/correction or the original claim reference will be returned for resubmission.

    Required Coding Elements and Timely Filing

    Required claim coding elements for corrected claimsmixed
    REF=F8Original Reference Number REF01=F8, REF02=internal control number (ICN/Molina Claim Number)
    CLM05-3Frequency code (last digit) of the bill type indicating xx7 or xx8
    NUCC/UB codesFrequency/resubmission codes per NUCC manual (CMS-1500) or UB Editor (UB-04): 1 Original, 7 Replacement, 8 Void/Cancel
    Timely filing windows for corrected claims
    General ruleTimely-filing limits for corrected claims vary by state and program; examples in the policy include 30, 90, 180, 365 days or up to 24 months depending on the state/program.
    Example - 30 daysSeveral Medicare/Marketplace and state-specific rules require corrected claims within 30 calendar days of the original remittance advice or as noted (e.g., Massachusetts Marketplace, some Medicare entries).
    Example - 90 daysMany Medicaid and Marketplace programs specify 90 calendar days from the remittance/adjudicated date for corrected claim submission in certain states (e.g., New Mexico, Mississippi references).
    Example - 180 days / 6 monthsSome Medicaid/Marketplace rules permit corrected claims within 180 calendar days or six months of the date of service or most recent adjudicated date, per state guidance.
    Example - 365 days / 1 yearNumerous state Medicare, Medicaid, and Marketplace rules require corrected claims within 365 calendar days (one year) of the date of service or most recent adjudicated/paid date.

    Submission Requirements for Corrected Claims

    Billing Rule

    Use frequency code 7 or 8 and reference the original claim/ICN

    Submit corrected claims as a replacement (frequency code 7) or a void/cancel (frequency code 8) and reference the original Molina claim number/ICN on the claim form or electronic transaction. Include the appropriate frequency/resubmission code in UB-04 FL4/FL64 or CMS-1500 FL22 and in the corresponding 837 loops so the submission is processed as an adjustment/void rather than an original claim.

    • Paper: enter original claim number in UB-04 FL64 or CMS-1500 FL22 and set UB-04 FL4 (bill type) to show xx7 or xx8 as applicable.
    • Electronic: populate CLM05-3 (frequency code) and use REF=F8 (original reference number/ICN) in the 837 transaction loop.

    Key Terms

    Corrected claim — definition
    DefinitionA corrected claim is a resubmission required when coding errors or missing information prevent accurate processing; it is treated as a new claim for processing and must reference the original claim number.
    Submission methodsMay be submitted on paper (standard red UB-04 or CMS-1500) or electronically via EDI/Provider Portal; paper claims must be free of handwritten or stamped content.
    Required referenceCorrected claims must reference the original Molina claim number (UB-04 FL64 or CMS-1500 FL22) or use the applicable 837 transaction loop (REF=F8 for electronic submissions).
    xx8 — bill type to cancel (void) an original paid claim
    Bill type 'xx8' meaningUse bill type 'xx8' to cancel (void) an original paid claim — it performs a single action to void/reverse the original payment.
    Usage notesApply 'xx8' only to previously paid claims (including zero-paid); resubmitting a denied claim is not a void/adjustment action.
    Form/location guidanceFor UB-04, the 3rd digit of the Type of Bill indicates 8 for reversals/voids (Type of Bill FL4); document control number goes in FL64 to reference the prior paid Molina claim number.
    xx7 — bill type to adjust a previously paid claim
    Bill type 'xx7' meaningUse bill type 'xx7' to adjust a previously paid claim by reversing the original claim and replacing it with corrected information.
    Field restrictions'xx7' cannot be used to change pay-to provider number, Molina member ID, or the original bill type submitted in error on the paid claim.
    Form/location guidanceFor UB-04, the 3rd digit of the Type of Bill indicates 7 for adjustments (Type of Bill FL4); for CMS-1500 use FL22 to indicate adjustment/reversal and include the original claim reference in FL64 or equivalent 837 REF=F8.
    Policy Summary
    PayerMolina Healthcare
    PolicyReimbursement Policy for Corrected Claims
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective DateSep 1, 2023
    Last ReviewSep 1, 2023
    Next Review DateN/A
    Key ActionSubmit corrected claims as replacement (frequency code 7) or void (frequency code 8) and reference the original Molina claim number/ICN with appropriate frequency/resubmission codes.
    SourceLink
    On This Page
    Corrected Claim Processing CriteriaRequired Coding Elements and Timely FilingSubmission Requirements for Corrected ClaimsKey Terms