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    v1.0.30
    OpenPayerPolicy UpdatesReimbursement/Payment PolicyWellpoint Corrected Claims Policy Update | OpenPay…
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    CurrentWellpointPolicy G-16001

    Reimbursement Policy: Corrected Claims

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    This policy governs Wellpoint Tennessee Medicaid reimbursement for corrected claims submitted by participating and nonparticipating providers and facilities. It establishes timely filing, submission-format, and documentation requirements for replacement or voided claims.

    Policy Summary
    PayerWellpoint Tennessee Medicaid
    PolicyReimbursement Policy: Corrected Claims
    Policy CodePolicy G-16001
    Change TypeAdministrative and clarifying revision
    Effective DateOctober 6, 2025
    Last ReviewOct 6, 2025
    Next Review DateNot specified
    Key ActionSubmit each corrected claim separately for each member and episode of care within the applicable timely filing period.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    120 daysParticipating provider filing period
    120 daysNonparticipating provider filing period
    2Accepted electronic frequency codes
    1 member/episodeSubmission unit

    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 Reimbursement Requirements

    Corrected Claim Reimbursement Requirements

    A corrected claim may be reimbursed when ALL of the following requirements are met:

    ALL of the following

    • The original claim was not considered a clean claim and requires correction.
    • The corrected claim is received within the applicable timely filing limit: 120 days from the last payment notification for participating providers and facilities, and 120 days from the last payment notification for nonparticipating providers and facilities.120 days from the last payment notification
    • A paper corrected claim is clearly marked "Corrected Claim," or an electronic corrected claim includes the applicable frequency code.
    • The corrected claim is submitted separately for each member and episode of care; batch, bulk, and packaged submissions are not accepted.

    Reasons for Rejection or Nonpayment

    A corrected claim may be rejected or not reimbursed if ANY of the following applies:

    ANY of the following

    • The corrected claim is filed beyond federal, state-mandated, or company standard timely filing limits.
    • The provider cannot provide documentation proving that the corrected claim was filed within the applicable filing limit when timely filing compliance is questioned.
    • The corrected claim is not appropriately identified, including failure to mark a paper submission "Corrected Claim" or include the applicable frequency code on an electronic submission.
    • The submission is made by batch, bulk, or packaged submission.

    Corrected Claim Coding and Filing Limits

    Corrected claim frequency codesmixed
    7Replacement of a Prior Claim
    8Void/Cancel of Prior Claim
    Standard correct codingmixed
    CPTCurrent Procedural Terminology codes
    HCPCSHealthcare Common Procedure Coding System codes
    RevenueRevenue codes
    Participating providers and facilities
    Filing limit120 days
    Filing period beginsFrom the last payment notification, including the Explanation of Payment or Remittance Advice
    Applies toParticipating providers and facilities
    Nonparticipating providers and facilities
    Filing limit120 days
    Filing period beginsFrom the last payment notification, including the Explanation of Payment or Remittance Advice
    Applies toNonparticipating providers and facilities

    How to Submit a Corrected Claim

    Billing Rule

    Meet Corrected-Claim Timely Filing Requirements

    Submit the corrected claim within the applicable timely filing period measured from the original claim’s last payment notification because the initial claim was not considered clean. The standard period is 120 days from the last Explanation of Payment or Remittance Advice for both participating and nonparticipating providers and facilities, unless a controlling requirement provides otherwise.

    • Corrected claims filed beyond federal, state-mandated, or company standard limits will not be approved.
    • The health plan may temporarily waive corrected-claim filing requirements after documented natural disasters or in accordance with applicable state guidance.
    Billing Rule

    Identify the Claim as Corrected

    Clearly identify every corrected claim so it is not treated as a duplicate submission.

    • For paper claims, clearly mark the claim “Corrected Claim.”
    • For electronic claims, include the applicable frequency code.
    • Failure to identify the claim appropriately may result in non-approval as a duplicate.
    Billing Rule

    Submit Claims Individually

    Submit each corrected claim separately for the applicable member and episode of care.

    • Do not submit corrected claims by batch, bulk, or packaged submission.
    Documentation Required

    Provide Proof of Timely Filing

    Maintain documentation proving that the corrected claim was filed within the applicable timely filing limit.

    • Services denied for failure to meet timely filing requirements are not subject to reimbursement unless the provider presents documentation showing the corrected claim was filed on time.
    Billing Rule

    Follow Controlling Requirements

    Review all requirements that may control or supersede the standard corrected-claim rules before submitting.

    • Account for provider, state, federal, CMS, and contractual requirements.
    • Apply any controlling requirement that differs from the standard filing period or submission process.

    Key Terms

    Corrected Claim
    Corrected ClaimThe resubmission of an entire claim as a replacement
    Omitted chargesA corrected claim may be submitted when charges were omitted
    Changed claim informationA corrected claim may be submitted when claim information changed
    Frequency Code
    Frequency CodeIndicates that a claim is a correction of a previously submitted and adjudicated claim
    Code 7Replacement of a Prior Claim
    Code 8Void/Cancel of Prior Claim
    Policy Summary
    PayerWellpoint Tennessee Medicaid
    PolicyReimbursement Policy: Corrected Claims
    Policy CodePolicy G-16001
    Change TypeAdministrative and clarifying revision
    Effective DateOctober 6, 2025
    Last ReviewOct 6, 2025
    Next Review DateNot specified
    Key ActionSubmit each corrected claim separately for each member and episode of care within the applicable timely filing period.
    SourceLink
    On This Page
    Corrected Claim Reimbursement RequirementsCorrected Claim Coding and Filing LimitsHow to Submit a Corrected ClaimKey Terms