CurrentWellpointPolicy G-16001

Corrected Claims

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Wellpoint New Jersey Medicaid reimbursement requirements for corrected claims submitted by participating and nonparticipating providers and facilities.

Policy Summary

PayerWellpoint

PolicyCorrected Claims

Policy CodePolicy G-16001

Change TypeAdministrative updateno material clinical or coverage change

Effective DateOctober 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, generally 365 calendar days from the date of service.

SourceLink

POLICY UPDATE CHANGES

The Definitions section was updated.

A definition of Corrected Claim was added to the policy history.

365 daysTimely filing limit

1 member/episodeSubmission scope

2 codesElectronic frequency codes

Not reimbursedUntimely claims

Corrected Claim Reimbursement Requirements

Policy Summary

PayerWellpoint

PolicyCorrected Claims

Policy CodePolicy G-16001

Change TypeAdministrative updateno material clinical or coverage change

Effective DateOctober 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, generally 365 calendar days from the date of service.

SourceLink

On This Page

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CurrentWellpointPolicy G-16001

Corrected Claims

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

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Wellpoint New Jersey Medicaid reimbursement requirements for corrected claims submitted by participating and nonparticipating providers and facilities.

Policy Summary

PayerWellpoint

PolicyCorrected Claims

Policy CodePolicy G-16001

Change TypeAdministrative updateno material clinical or coverage change

Effective DateOctober 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, generally 365 calendar days from the date of service.

SourceLink

POLICY UPDATE CHANGES

The Definitions section was updated.

A definition of Corrected Claim was added to the policy history.

365 daysTimely filing limit

1 member/episodeSubmission scope

2 codesElectronic frequency codes

Not reimbursedUntimely claims

Corrected Claim Reimbursement Requirements

Policy Summary

PayerWellpoint

PolicyCorrected Claims

Policy CodePolicy G-16001

Change TypeAdministrative updateno material clinical or coverage change

Effective DateOctober 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, generally 365 calendar days from the date of service.

SourceLink

On This Page

Corrected Claim Reimbursement Requirements

Corrected claims are 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.
The corrected claim must be submitted within the timely filing limit because the initial claim was not considered a clean claim.
Applicable standard timely filing limit
- The provider or facility is participating.365 calendar days from date of service
- The provider or facility is nonparticipating.365 calendar days from date of service
The corrected claim is properly identified based on submission method
- A paper claim is clearly marked 'Corrected Claim.'
- An electronic claim includes the applicable frequency code.
The corrected claim is submitted separately for each member and episode of care.
Batch, bulk, or packaged submissions are not accepted.
The claim is within the filing limit or an exception applies
- The corrected claim is filed within the applicable federal, state-mandated, or company standard timely filing limit.
- For a claim filed beyond the applicable timely filing limit, the provider presents documentation proving that the corrected claim was filed within the applicable filing limit.
- The health plan has temporarily waived corrected claim filing requirements following a documented natural disaster or in accordance with applicable state guidance.

Corrected Claim Coding and Filing Limits

Electronic corrected-claim frequency codesmixed

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

Standard and compliant codingmixed

No codes listed

Corrected Claim Timely Filing Period

Participating providers and facilities365 calendar days from the date of service

Nonparticipating providers and facilities365 calendar days from the date of service

Filing exceptionApplicable provider, state, federal, or CMS contracts and/or requirements may indicate otherwise

Corrected Claim Submission Checklist

Billing Rule

Meet Corrected-Claim Timely Filing Requirements

Submit the corrected claim within the applicable timely filing limit for the original claim when the initial claim was not a clean claim, unless provider, state, federal, or CMS contracts or requirements indicate otherwise.

Participating providers and facilities: 365 calendar days from the date of service.
Nonparticipating providers and facilities: 365 calendar days from the date of service.
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 Corrected Claim Correctly

Identify the submission as a corrected claim so it is not treated as a duplicate and denied for improper claim identification.

Paper claims: Clearly mark the claim “Corrected Claim.”
Electronic claims: Include the applicable frequency code.

Billing Rule

Submit Corrections Separately

Submit each correction separately. The health plan will not accept corrected claims submitted by batch, bulk, or packaged submission.

Submit one corrected claim for each member.
Submit one corrected claim for each episode of care.

Documentation Required

Document Timely Filing

Retain documentation demonstrating that the corrected claim was filed within the applicable timely filing limit. Documentation is required when requesting reimbursement for services denied for untimely filing.

Documentation must prove the corrected claim was submitted within the applicable filing limit.
The applicable limit may be a federal, state-mandated, company-standard, or other contractually applicable requirement.

Denial Risk

Avoid Untimely Filing Denial

Corrected claims filed beyond applicable federal, state-mandated, or company-standard timely filing limits will not be approved because they are outside the timely filing limit. Services denied for failure to meet timely filing requirements are not reimbursable unless the provider presents documentation proving timely corrected-claim submission.

Key Corrected Claim Terms

Corrected Claim

Corrected ClaimThe resubmission of an entire claim as a replacement due to omitted charges or changed claim information

Submission purposeReplaces a prior claim when charges were omitted or claim information changed

Required scopeThe entire claim must be resubmitted as a replacement

Frequency Code

Frequency CodeIndicates that a claim is a correction of a previously submitted and adjudicated claim

Replacement of a prior claimUse frequency code 7

Void or cancel of a prior claimUse frequency code 8