CurrentWellpointPolicy G-16001

Reimbursement Policy Corrected Claims

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Guidelines for reimbursement of corrected claims, including timely filing, frequency-code, documentation, and separate-submission requirements for participating and nonparticipating providers and facilities in Iowa.

Policy Summary

PayerWellpoint

PolicyReimbursement Policy Corrected Claims

Policy CodePolicy G-16001

Change TypeAdministrative updateno material coverage or clinical changes

Effective DateOctober 6, 2025

Next Review DateNot specified

Key ActionSubmit corrected claims within the applicable timely filing limit, generally 365 days from the last date of adjudication.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

365 daysCorrected-claim filing period

2 yearsAbsolute reimbursement limit

-7 and -8Electronic frequency codes

1 member and episodeSubmission requirement

Corrected-Claim Reimbursement Requirements

Corrected-claim reimbursement requirements

Corrected-claim reimbursement is available when ALL of the following requirements are met; reimbursement remains subject to applicable benefit, authorization, medical necessity, coding, billing, provider, state, federal, CMS, and plan requirements.

ALL of the following

The corrected claim is received within the applicable timely filing limit for the original claim, generally within 365 days from the last date of adjudication for participating and nonparticipating providers and facilities.
The claim is not submitted more than two years after the date of service.
An electronic corrected claim includes the applicable frequency code, such as -7 for replacement of a prior claim or -8 for void or cancel of a prior claim.
The corrected claim is submitted separately for each member and episode of care; batch, bulk, and packaged submissions are not accepted.

Policy Summary

PayerWellpoint

PolicyReimbursement Policy Corrected Claims

Policy CodePolicy G-16001

Change TypeAdministrative updateno material coverage or clinical changes

Effective DateOctober 6, 2025

Next Review DateNot specified

Key ActionSubmit corrected claims within the applicable timely filing limit, generally 365 days from the last date of adjudication.

SourceLink

On This Page

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.

CurrentWellpointPolicy G-16001

Reimbursement Policy Corrected Claims

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Get alerted when Policy G-16001 changes without checking for updates manually.

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Policy Summary

PayerWellpoint

PolicyReimbursement Policy Corrected Claims

Policy CodePolicy G-16001

Change TypeAdministrative updateno material coverage or clinical changes

Effective DateOctober 6, 2025

Next Review DateNot specified

Key ActionSubmit corrected claims within the applicable timely filing limit, generally 365 days from the last date of adjudication.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

365 daysCorrected-claim filing period

2 yearsAbsolute reimbursement limit

-7 and -8Electronic frequency codes

1 member and episodeSubmission requirement

Corrected-Claim Reimbursement Requirements

Corrected-claim reimbursement requirements

ALL of the following

The corrected claim is received within the applicable timely filing limit for the original claim, generally within 365 days from the last date of adjudication for participating and nonparticipating providers and facilities.
The claim is not submitted more than two years after the date of service.
An electronic corrected claim includes the applicable frequency code, such as -7 for replacement of a prior claim or -8 for void or cancel of a prior claim.
The corrected claim is submitted separately for each member and episode of care; batch, bulk, and packaged submissions are not accepted.

Policy Summary

PayerWellpoint

PolicyReimbursement Policy Corrected Claims

Policy CodePolicy G-16001

Change TypeAdministrative updateno material coverage or clinical changes

Effective DateOctober 6, 2025

Next Review DateNot specified

Key ActionSubmit corrected claims within the applicable timely filing limit, generally 365 days from the last date of adjudication.

SourceLink

On This Page

Filing Limits and Frequency Codes

Corrected-claim frequency codesModifier

-7	Replacement of a prior claim
-8	Void or cancel of a prior claim

Corrected-claim timely filing period

Participating providers and facilities365 days from the last date of adjudication

Nonparticipating providers and facilities365 days from the last date of adjudication

Filing basisThe corrected claim must be received within the applicable timely filing limit for the original claim

Absolute reimbursement limit

Maximum reimbursement periodTwo years from the date of service

Claims submitted past the limitWill not be reimbursed

Limit measured fromThe date of service

How to Submit a Corrected Claim

Billing Rule

Meet corrected-claim timely filing

Submit the corrected claim within the applicable timely filing requirement for the original claim. The standard is 365 days from the last date of adjudication for participating and nonparticipating providers and facilities.

Denial Risk

Correct non-clean claims timely

Submit the corrected claim within the timely filing limit when the initial claim was not considered a clean claim. Claims filed beyond applicable federal, state-mandated, or company standard timely filing limits will not be approved.

Billing Rule

Use the corrected-claim frequency code

For electronic corrected claims, use the applicable frequency code to identify the claim appropriately. Failure to mark the claim appropriately may result in the claim not being approved as a duplicate.

Frequency code -7: replacement of a prior claim.
Frequency code -8: void or cancel of a prior claim.

Documentation Required

Provide proof of timely filing

Maintain and present documentation proving that the corrected claim was filed within the applicable filing limit if reimbursement is denied for failure to meet timely filing requirements. Services otherwise not approved for failure to meet timely filing requirements are not subject to reimbursement without this documentation.

Billing Rule

Submit claims separately

Submit corrected claims separately for each member and episode of care. Batch, bulk, and packaged submissions are not accepted.

Corrected-Claim Terminology

Corrected Claim

Corrected ClaimThe resubmission of an entire claim as a replacement

Reason for resubmissionOmitted charges or changed claim information

Claim replacedA previously submitted claim

Frequency Code

Frequency CodeIndicates that the claim is a correction

Prior claim statusThe prior claim was previously submitted and adjudicated

UseIdentifies a corrected claim

Frequency Code -7

Code-7

MeaningReplacement of a prior claim

Claim actionReplaces the prior claim

Frequency Code -8

Code-8

MeaningVoid/cancel of prior claim

Claim actionVoids or cancels the prior claim