CurrentMolina HealthcarePolicy N/A

Corrected Claims / Claim Adjustments Reimbursement Policy

Governance of how providers must submit corrected, replacement, adjustment, and voided claims to Molina Healthcare and the rules for processing and timely filing; applies to Molina providers submitting claims for Molina members.

Policy Summary

PayerMolina Healthcare

PolicyCorrected Claims / Claim Adjustments Reimbursement Policy

Policy CodePolicy N/A

Change TypeFormatting update (non-material)

Effective DateN/A

Next Review DateN/A

Key ActionSubmit corrected claims as replacement (837I) or corrected (837P) claims and include the original Molina claim number and appropriate frequency/resubmission codes.

SourceLink

POLICY UPDATE CHANGES

Updated formatting of the policy.

xx7 / xx8bill type codes

FL64UB-04 original claim field

FL22CMS-1500 original claim field

State-specifictimely filing windows

Corrected / Adjustment Claim Acceptance Criteria

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Corrected/Adjustment claim acceptance criteria

Covered when ALL of the following are met:

Adjusted/void claims apply only to previously paid claims (including zero-paid). Resubmitting a denied claim is not an adjustment.

Corrected claims submitted after federal, state-mandated, or company-defined timely filing limits will be denied unless provider can document submission within the designated filing deadline.

State- and program-specific timely filing windows apply. Examples include: Arizona Medicare: 30 days from original remittance advice; California Medicare: 365 calendar days from most recent adjudicated date; Washington Medicare: 24 months from original remittance advice. (See state listings for full details.)

Paper claim requirements: use standard red UB-04 or CMS-1500 with no handwritten or stamped content; include the original Molina claim number in UB-04 FL64 (Document Control Number) or CMS-1500 FL22 (Adjustment/Reversal) as applicable.

Electronic transaction requirements: indicate replacement or corrected transaction type and reference original claim number (use 837I for replacements, 837P for corrected claims); set frequency/bill-type indicator to 7 for adjustments (xx7) or 8 for reversals/voids (xx8) per 5010X222 837 formatting (CLM05-3 / bill type last digit).

Claim Coding, Frequency and Reference Fields

Reference and frequency fields for adjusted claimsmixed

F8	REF01=F8 indicates Original Reference Number; REF02 is Molina internal control number (ICN / Molina Claim Number)

Frequency / Bill type last digit

RequirementFrequency / bill type last digit must be 7 (adjustment) or 8 (reversal/void).

EDI fieldCLM05-3 (Frequency code — last digit of bill type) must reflect '7' or '8'.

UB-04 / CMS-1500 placementInclude the appropriate frequency/resubmission code in field 4 of UB-04 and field 22 of CMS-1500 when submitting corrected claims.

Reference guidanceFrequency/resubmission codes are defined in the NUCC manual (CMS-1500) and the UB Editor (UB-04).

Submission Requirements and Billing Actions for Corrected Claims

Billing Rule

Submission Requirements for Corrected Claims

Submit corrected claims as replacement (837I) or corrected (837P) claims; include the original claim number and the appropriate frequency/resubmission fields. Corrected claims must indicate whether they are replacements or corrections and must reference the original Molina claim (ICN). Claims missing the correct coding or original claim reference will be returned for resubmission. Paper corrected claims must be free of handwritten or stamped content and submitted on standard red UB-04 or CMS-1500 forms. For paper submissions, insert the original claim number in UB-04 field 64 or CMS-1500 field 22. For electronic submissions, populate the applicable 837 transaction loop (e.g., 2300 REF=F8 with REF01=F8 and REF02 = Molina internal control number/ICN) and set CLM05-3 to the proper frequency code. Use NUCC/UB frequency/resubmission codes to indicate the claim type.

Paper claims: no handwritten or stamped content; use red UB-04 or CMS-1500 forms.
Paper original claim reference: UB-04 field 64 or CMS-1500 field 22.
Electronic original claim reference: 2300 REF=F8, REF02 = Molina ICN (original claim number).
Electronic frequency code: CLM05-3 = last digit of bill type (xx7 or xx8) and include the appropriate NUCC/UB resubmission code on the 837.

Billing Rule

Adjustment / Void Bill Types and Limitations

Use the specified bill types when submitting adjustments or voids for previously paid Molina claims. Bill type 'xx8' is used to void/reverse a paid claim and will cancel the entire payment. Bill type 'xx7' is used to adjust and replace a paid claim — it reverses the original claim and replaces it with corrected information. Do not use adjustments to change the pay-to provider number, Molina member consumer ID, or the original bill type submitted in error; these fields cannot be changed via an xx7 adjustment. When submitting an adjustment electronically in the 5010X222 837 format, ensure CLM05-3 reflects the frequency code (xx7 or xx8) and include 2300 REF=F8 with REF02 set to the original Molina ICN.

Use bill type 'xx8' to cancel (void/reverse) an entire paid claim payment.
Use bill type 'xx7' to adjust and replace a previously paid claim (reverse then replace).
Do NOT use adjustments to change: pay-to provider number, Molina member consumer ID, or original bill type.
Electronic adjustment key fields: CLM05-3 = frequency code (xx7 or xx8); 2300 REF=F8 with REF02 = original Molina ICN.

Key Definitions

Corrected Claim — definition

DefinitionA Corrected Claim is a submission that rectifies coding errors or missing information preventing Molina from accurately processing the original claim; corrected claims are treated as new claims for processing purposes.

Submission formatsCorrected claims may be submitted on paper (standard red UB-04 or CMS-1500) or electronically via EDI (837I/837P) or the Provider Portal.

Paper claim rulesPaper claims must be free of handwritten or stamped content and must include the original claim number in FL64 (UB-04) or FL22 (CMS-1500).

When to useExamples include missing/updated/invalid modifiers, CPT/HCPCS/Revenue/NDC codes, missing supporting documentation, or changes to charges/units.

xx7 / xx8 — bill type meanings

xx7 (Adjustment)Bill Type 'xx7' adjusts a previously paid claim by reversing the original claim and replacing it with corrected information; cannot be used to change pay-to provider number, member ID, or original bill type.

xx8 (Void/Reversal)Bill Type 'xx8' voids or reverses a previously paid claim by canceling the original payment (single action).

ScopeAdjustments and voids apply only to previously paid claims (including zero-paid); resubmitting a denied claim is not an adjustment.

837I / 837P — replacement vs corrected transactions

837I vs 837PUse 837I to indicate a replacement (reverse and replace) and 837P to indicate a corrected claim; the transaction must specify whether it is a replacement or corrected submission.

Original claim referenceInclude the original claim number in the electronic transaction (REF=F8 with REF02 = Molina internal control number / ICN) to identify the claim being voided, reversed, or replaced.

Key electronic field2300 REF=F8 is used to carry the Original Reference Number (REF01=F8, REF02=ICN/Molina Claim Number) for adjustment claims.