To understand this rejection, we need to explain two items that go on corrected claims.
- Frequency Code (this is what they are referencing as CLM05-03)
- Control Number
Frequency code (CLM05-03)
The frequency code is a code on the claim that references the type of submission. Usually, this code is set to 1 (for original claim). However, if you file a corrected claim, you would set this to either 6 or 7. The code 6 is labeled as corrected claim and the code 7 is labeled as replace submitted claim. It can be tough sometimes knowing what code a payer will want. If you need to file a corrected claim, it is best to first know what frequency code the payer accepts. For more information see: Filing a corrected claim in Therabill.
The control number is a reference code you put on the claim to reference a claim the payer already has in their system. You need to get this reference code from the payer (it is often found on the Explanation of Benefits or Payer Claim Summary. Putting the control number on the claim allows the payer to find the claim that you are referencing in their system.
So why am I receiving this rejection?
In the rejection message, the payer is stating that they do not accept frequency code that you used. You may try using the other frequency code or give the payer a call to find out what frequency code they require.
What is the difference between frequency code 6 and frequency code 7?
Frequency code 6 is corrected claim and frequency code 7 is replace submitted claim. The difference is in how the payer handles it on their end. Corrected claim would mean that they (the payer) are going to keep the original claim you submitted and make changes to it based on the information in the new claim (with frequency code 6). When you use frequency code 7, the new claim that you submit will take the place of the old claim.
Unfortunately, some payers will only allow certain frequency codes.