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    v1.0.28
    OpenPayerPolicy UpdatesReimbursement/Payment PolicyMolina Healthcare Corrected Claims Policy Update |…
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    CurrentMolina HealthcarePolicy N/A

    Corrected Claims Policy

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    Defines Molina Healthcare's requirements and timelines for submitting corrected (replacement/adjustment/void) claims, how they are coded and submitted, and who is affected (providers submitting CMS-1500, UB-04 or electronic 837P/837I corrected claims).

    Policy Summary
    PayerMolina Healthcare
    PolicyCorrected Claims Policy
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective Date
    Last ReviewJun 4, 2025
    Next Review DateApr 9, 2025
    Key ActionSubmit corrected claims as replacement or corrected claims via paper (red UB-04 or CMS-1500) or electronically via EDI and include the original claim number and proper frequency/resubmission code.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    xx7 / xx8Adjustment / Reversal bill types
    Field 64 / FL22Reference fields for original claim
    1,7,8Common frequency codes
    30–730dTimely filing windows

    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 Requirements and Timely Filing

    Corrected claim requirements and timely filing

    When corrected claim submissions are applicable and how they are treated:

    Adjustments and voids apply only to previously paid claims (including zero-paid claims); resubmitting a denied claim is not an adjustment.
    Corrected claims must reference the original paid claim number (FL64 on UB-04, FL22 on CMS-1500 or 2300 REF=F8 in 837).
    Paper corrected claims must be free of handwritten or stamped content and submitted on standard red UB-04 or CMS-1500 forms.
    Corrected claims must include the proper coding to indicate replacement or correction (appropriate frequency/resubmission code and 837I/837P fields); claims lacking correct coding will be returned for resubmission.
    Use bill type third-digit frequency: '7' for Adjustment (replace/adjust a previously paid claim) and '8' for Reversal/Void (cancel a paid claim); do not use adjustment processes for denied claims.
    Corrected claims submitted after applicable timely filing limits (federal, state-mandated, or company-defined) will be denied unless the provider can document timely submission.

    State/program timing examples

    • Arizona (Medicare): corrected claims must be sent within 30 days of the original remittance advice date.
    • Many states (e.g., CA, FL, KY, NM, OH, SC, TX) and general guidance: corrected claims must be submitted within 365 calendar days of date of service or most recent adjudicated/paid date as specified by state/program or Provider Service Agreement.
    • Washington: certain programs allow corrected claims up to 24 months; providers must follow the timeframe applicable to the member/program and Provider Service Agreement.
    • Other state-specific examples include Massachusetts and New York (30 calendar days of original RA) and Michigan (365 days from date of service or within 90 days of most recent adjudicated date).
    For electronic submissions, include the original claim reference in the appropriate 2300 REF loop (REF01=F8 and REF02 = Molina ICN) and set the correct frequency/resubmission code in the transaction; for paper, populate FL64 (UB-04) or FL22 (CMS-1500) with the original claim number.
    Do not use adjustment/reversal processes to change pay-to provider number, Molina member consumer ID, or original bill type on a previously paid claim.

    Claim Fields and Resubmission Codes

    Key 837/claim fields for corrected claimsmixed
    CLM05-3Frequency code (last digit) of the Bill type; must be 'xx7' or 'xx8' for adjustments/voids.
    2300 REF=F8Original Reference Number (REF01=F8 and REF02 = Molina Internal Control Number/ICN).
    Resubmission frequency codes
    1Original Claim
    7Replacement of Prior Claim
    8Void/Cancel Prior Claim

    Submission Methods and Adjustment/Reversal Actions

    Billing Rule

    How to submit corrected claims (paper or electronic) and required references

    Submit corrected claims as replacement or corrected claims via paper (red UB‑04 or CMS‑1500) or electronically via EDI (clearinghouse or Provider Portal). Include the original claim number (FL64 on UB‑04 or FL22 on CMS‑1500, or 2300 REF=F8 in the 837 with REF02 = Molina ICN) and the appropriate frequency/resubmission code to indicate replacement or correction. Paper claims must be free of handwritten or stamped content and submitted on the standard red UB‑04 or CMS‑1500 forms; claims lacking correct coding will be returned for resubmission.

    • Original claim number: UB‑04 field 64 or CMS‑1500 field 22 (or 2300 REF=F8 in 837 with REF02 = Molina ICN).
    • Include appropriate frequency/resubmission code in UB‑04 field 4 or CMS‑1500 field 22 / CLM05-3 on 837.
    • Paper claims must be free of handwritten or stamped content and on standard red forms.
    • Electronic submissions via EDI must complete the applicable 837I/837P fields to indicate replacement/correction.
    Billing Rule

    Voids (xx8) and adjustments/replacements (xx7) — operational billing rules

    To void/cancel or adjust previously paid claims use the insurer-specific bill-type conventions: submit bill type 'xx8' to void/cancel a paid claim and 'xx7' to adjust and replace a previously paid claim. Do not use adjustment bill types for denied claims; adjustments and voids apply only to previously paid claims.

    • Use bill type 'xx8' to cancel (void) an original paid claim.
    • Use bill type 'xx7' to reverse and replace a previously paid claim (cannot be used to change pay‑to provider number, Molina member ID, or original bill type).
    • Do not submit adjustments for claims that were denied; adjustments/voids are only for previously paid claims.

    Terminology and Form Definitions

    Corrected Claim — definition
    DefinitionA corrected claim is a submission made to correct coding or information on a previously submitted claim; adjustments and voids apply exclusively to previously paid claims (including zero-paid claims); resubmitting a denied claim is not an adjustment.
    Reference original claimCorrected claims must reference the original paid claim number (FL64 on UB-04, FL22 on CMS-1500 or 2300 REF=F8 in 837).
    Timely filingCorrected claims submitted after federal, state-mandated, or company-defined timely filing limits will be denied unless documentation shows timely submission.
    Billing form and code definitions
    CMS-1500 (837P)Standard professional claim form used by physicians and non-physician practitioners for billing professional services (also referenced via 837P electronic format).
    UB-04Institutional claim form used for inpatient and outpatient facility billing; type of bill and form locators (e.g., FL4 Type of Bill, FL64 Document Control Number) are used to indicate original vs corrected claims.
    NUCCNational Uniform Claim Committee — organization responsible for designing and maintaining the CMS-1500 claim form.
    CPT / HCPCSProcedure coding systems used to report services and supplies on claims; HCPCS includes alphanumeric codes mandated for certain items and services by Medicare.
    NDCNational Drug Code — unique identifier for drugs regulated by FDA, used when reporting drug products on claims.
    EOBExplanation of Benefits — statement from the insurer summarizing how a claim was processed; not a bill but explains payments and member liability.
    Policy Summary
    PayerMolina Healthcare
    PolicyCorrected Claims Policy
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective Date
    Last ReviewJun 4, 2025
    Next Review DateApr 9, 2025
    Key ActionSubmit corrected claims as replacement or corrected claims via paper (red UB-04 or CMS-1500) or electronically via EDI and include the original claim number and proper frequency/resubmission code.
    SourceLink
    On This Page
    Corrected Claim Requirements and Timely FilingClaim Fields and Resubmission CodesSubmission Methods and Adjustment/Reversal ActionsTerminology and Form Definitions