CurrentWellpointPolicy G-16001

Reimbursement Policy Corrected Claims

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This policy governs when Wellpoint Maryland Medicaid reimburses corrected claims and the filing, submission, and documentation requirements for participating and nonparticipating providers and facilities.

Policy Summary

PayerWellpoint Maryland Medicaid

PolicyReimbursement Policy Corrected Claims

Policy CodePolicy N/A

Change TypeDefinitions update

Effective DateOct 6, 2025

Last ReviewOct 6, 2025

Next Review DateN/A

Key ActionSubmit each corrected claim separately for each member and episode of care within the applicable timely filing limit.

SourceLink

POLICY UPDATE CHANGES

The Definitions section was updated.

12 monthsDate-of-service filing period

60 daysAlternative filing period

2Electronic frequency codes

1 member/episodeSubmission unit

Corrected Claim Reimbursement Criteria

Policy Summary

PayerWellpoint Maryland Medicaid

PolicyReimbursement Policy Corrected Claims

Policy CodePolicy N/A

Change TypeDefinitions update

Effective DateOct 6, 2025

Last ReviewOct 6, 2025

Next Review DateN/A

Key ActionSubmit each corrected claim separately for each member and episode of care within the applicable timely filing limit.

SourceLink

On This Page

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CurrentWellpointPolicy G-16001

Reimbursement Policy Corrected Claims

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Policy Summary

PayerWellpoint Maryland Medicaid

PolicyReimbursement Policy Corrected Claims

Policy CodePolicy N/A

Change TypeDefinitions update

Effective DateOct 6, 2025

Last ReviewOct 6, 2025

Next Review DateN/A

Key ActionSubmit each corrected claim separately for each member and episode of care within the applicable timely filing limit.

SourceLink

POLICY UPDATE CHANGES

The Definitions section was updated.

12 monthsDate-of-service filing period

60 daysAlternative filing period

2Electronic frequency codes

1 member/episodeSubmission unit

Corrected Claim Reimbursement Criteria

Policy Summary

PayerWellpoint Maryland Medicaid

PolicyReimbursement Policy Corrected Claims

Policy CodePolicy N/A

Change TypeDefinitions update

Effective DateOct 6, 2025

Last ReviewOct 6, 2025

Next Review DateN/A

Key ActionSubmit each corrected claim separately for each member and episode of care within the applicable timely filing limit.

SourceLink

On This Page

Corrected Claim Reimbursement Criteria

A corrected claim may be reimbursed when ALL applicable criteria below are met, subject to provider, state, federal, CMS, and member benefit plan requirements.

ALL of the following

The corrected claim is received within the applicable timely filing requirement for the original claim because the initial claim was not considered a clean claim.
The standard timely filing limit is the later of 12 months from the date of service or 60 days from the date the claim was last received or rejected by the health plan. This applies to participating and nonparticipating providers and facilities.
One of the following submission requirements applies
- A paper corrected claim is clearly marked Corrected Claim.
  Failure to mark the paper 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.
The claim uses proper billing and submission guidelines, including industry-standard, compliant CPT, HCPCS, and/or revenue codes appropriate to the services or procedures performed.
The billed codes must be fully supported by the medical record and/or office notes.
The services, procedures, or items are covered under the member's benefit plan and meet applicable authorization and medical necessity guidelines for the procedure, diagnosis, and member's state of residence.
Coverage under the member's benefit plan does not by itself guarantee reimbursement.
No applicable provider, state, federal, or CMS contract or requirement supersedes or modifies these corrected-claim reimbursement criteria.
These policies may be superseded by applicable mandates and requirements.

Timely filing exception or consequence

The provider presents documentation proving that the corrected claim was filed within the applicable timely filing limit.
Documentation may support reimbursement when a service was not approved for failure to meet timely filing requirements.
The health plan has temporarily waived corrected-claim filing requirements following a documented natural disaster or in accordance with applicable state guidance.
The corrected claim was filed within the applicable federal, state-mandated, or company standard timely filing limit.
Corrected claims filed beyond those limits will not be approved, and services denied for failure to meet timely filing requirements are not subject to reimbursement unless timely filing is proven with documentation.

Corrected Claim Coding and Filing Limits

Corrected claim frequency codesmixed

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

Corrected Claim Timely Filing Limit

Timely filing limitLater of 12 months from the date of service or 60 days from the date the claim was last received or rejected by the health plan.

Applicable providersApplies to participating and nonparticipating providers and facilities.

Claim identificationPaper claims must be clearly marked "Corrected Claim"; electronic claims must include the applicable frequency code.

Separate submissionSubmit each corrected claim separately for each member and episode of care; batch, bulk, or packaged submissions are not accepted.

Late filingClaims filed beyond applicable federal, state-mandated, or company timely filing limits are not approved unless documentation proves timely filing.

Submitting and Supporting Corrected Claims

Billing Rule

Submit and identify corrected claims

Submit each corrected claim within the applicable timely filing limit for the original claim: the later of 12 months from the date of service or 60 days from the date the claim was last received or rejected by the health plan. Clearly mark paper claims “Corrected Claim,” include the applicable frequency code on electronic claims, and submit each corrected claim separately for each member and episode of care.

Batch, bulk, or packaged submissions are not accepted.
Claims filed beyond applicable timely filing limits will not be approved unless documentation proves the corrected claim was filed within the limit.

Documentation Required

Support corrected claims with compliant documentation

Ensure corrected claims and supporting records comply with applicable provider, state, federal, CMS, authorization, medical necessity, and coding requirements. Claims that do not meet applicable requirements may be rejected or denied, and payment may be recovered, recouped, or adjusted.

Use proper, compliant CPT, HCPCS, and/or revenue codes.
Ensure billed services and procedures are fully supported in the medical record and/or office notes.

Reimbursement Policy Corrected Claims

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Corrected Claim Reimbursement Criteria

Reimbursement Policy Corrected Claims

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Corrected Claim Reimbursement Criteria

Corrected Claim Coding and Filing Limits

Submitting and Supporting Corrected Claims

Corrected Claim Terminology