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    v1.0.28
    OpenPayerPolicy UpdatesReimbursement/Payment PolicySimply Healthcare corrected claims Update | OpenPa…
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    CurrentSimply Healthcare Plans, Inc. and Clear Health AlliancePolicy G-16001

    Reimbursement Policy — Corrected Claims

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    Governs reimbursement of corrected claims for participating and nonparticipating providers and facilities serving Florida Medicaid Managed Care and Florida Healthy Kids members, including timely filing, claim submission, frequency codes, and documentation requirements.

    Policy Summary
    PayerSimply Healthcare Plans, Inc. and Clear Health Alliance
    PolicyReimbursement Policy — Corrected Claims
    Policy CodePolicy G-16001
    Change TypeAdministrative definition updateno material clinical or coverage change
    Effective DateOctober 6, 2025
    Last ReviewOct 6, 2025
    Next Review DateNot specified
    Key ActionSubmit each corrected claim separately within the applicable timely filing limit, clearly marking paper claims or including the applicable electronic frequency code.
    SourceLink
    POLICY UPDATE CHANGES

    The Definitions section was updated as part of the review approved and effective October 6, 2025.

    The policy history records that a definition of Corrected Claim was added in the August 28, 2023 review.

    12 monthsParticipating provider filing limit
    12 monthsNonparticipating provider filing limit
    2Electronic frequency codes

    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.

    1 member/episodeSubmission requirement

    Corrected Claim Reimbursement Criteria

    Corrected Claim Reimbursement Criteria

    A corrected claim is eligible for reimbursement when ALL applicable requirements below are met, unless provider, state, federal, or CMS contracts or requirements indicate otherwise.

    ALL of the following

    • The corrected claim is received within the applicable timely filing limit for the original claim because the initial claim was not considered a clean claim.Within 12 months from the date of service

      The standard timely filing limit is 12 months from the date of service for both participating and nonparticipating providers and facilities, unless a different contractual, state, federal, or CMS requirement applies.

    • A paper corrected claim is clearly marked Corrected Claim.

      Failure to mark the claim appropriately may result in the claim not being approved as a duplicate.

    • An electronic corrected claim includes the applicable frequency code.

      Failure to use the applicable frequency code may result in the claim not being approved as a duplicate.

    • The corrected claim is submitted separately for each member and episode of care.

      Batch, bulk, or packaged corrected-claim submissions are not accepted.

    Timely Filing Denial Criteria

    A corrected claim will not be approved when it is filed outside the applicable timely filing limit, subject to documented proof of timely submission and any superseding requirements.

    ALL of the following

    • The corrected claim is filed beyond the applicable federal, state-mandated, or company-standard timely filing limit.Beyond the applicable filing limit
    • The provider does not present documentation proving that the corrected claim was filed within the applicable filing limit.

      Services denied for failure to meet timely filing requirements are not subject to reimbursement unless timely filing is documented.

    Temporary Filing Waiver

    The health plan may temporarily waive corrected-claim filing requirements when the waiver conditions below apply.

    ANY of the following

    • A documented natural disaster has affected corrected-claim filing.
    • Applicable state guidance supports a temporary waiver of corrected-claim filing requirements.

    Corrected Claim Coding and Filing Limits

    Electronic corrected-claim frequency codesmixed
    -7Replacement of a Prior Claim
    -8Void/Cancel of Prior Claim
    Participating Provider and Facility
    Timely filing period12 months
    Filing period measured fromDate of service
    Applies toParticipating providers and facilities
    Nonparticipating Provider and Facility
    Timely filing period12 months
    Filing period measured fromDate of service
    Applies toNonparticipating providers and facilities

    Submitting Corrected Claims

    Billing Rule

    Submit and identify corrected claims properly

    Submit the corrected claim within the applicable timely filing limit for the original claim. Clearly mark paper claims “Corrected Claim”; electronic corrected claims must include the applicable frequency code.

    Billing Rule

    Submit corrected claims individually

    Submit a separate corrected claim for each member and episode of care. Batch, bulk, or packaged submissions cannot be accepted.

    Documentation Required

    Key Terms

    Corrected Claim
    Corrected ClaimThe resubmission of an entire claim as a replacement
    PurposeTo replace a previously submitted claim
    Applicable whenCharges were omitted or claim information changed
    Frequency Code
    Frequency CodeIndicates that the claim is a correction of a previously submitted and adjudicated claim
    Replacement of a Prior Claim-7
    Void/Cancel of Prior Claim-8
    Policy Summary
    PayerSimply Healthcare Plans, Inc. and Clear Health Alliance
    PolicyReimbursement Policy — Corrected Claims
    Policy CodePolicy G-16001
    Change TypeAdministrative definition updateno material clinical or coverage change
    Effective DateOctober 6, 2025
    Last ReviewOct 6, 2025
    Next Review DateNot specified
    Key ActionSubmit each corrected claim separately within the applicable timely filing limit, clearly marking paper claims or including the applicable electronic frequency code.
    SourceLink
    On This Page
    Corrected Claim Reimbursement CriteriaCorrected Claim Coding and Filing LimitsSubmitting Corrected ClaimsKey Terms

    Document timely filing

    Maintain documentation proving that the corrected claim was filed within the applicable filing limit if reimbursement is denied for untimely filing.

    Denial Risk

    Avoid untimely corrected claims

    Corrected claims filed beyond federal, state-mandated, or company standard timely filing limits will not be approved unless the provider presents documentation proving that the corrected claim was filed within the applicable filing limit.