Whether you Resubmit or file a Corrected Claim depends on how the insurance company handled your original submission and their policies on resending claims. For more information, please see: Rejection versus Denial.
In general, if a claim was denied you may need to submit a corrected claim. It is always best to call the payer if you are not yet sure how they want claims re-sent. Some payers do not accept Corrected Claims and want corrections sent as a brand new claim. If the payer tells you that you need to file a corrected claim, get the details of how it should be filed. Below is a guideline for how you might approach this.
Note: The Control Number may also be referred to as a Claim Reference Number or ICN.
Creating a Corrected Claim
Note: If you need to update any information on the claim, make all of the changes prior to create the claim.
Electronic with New Information
- After the changes have been made to the client/session, ensure it is in the Bill Insurance queue. This can be done by selecting Resubmit or Send to insurance invoice area as the action when posting a payment.
- Create the claim as Print & Mail. We will be switching it to electronic at a later point.
- Navigate to Filing > CMS-1500 and locate the claim.
- Select the icon and click Create Corrected Claim. A new window will display.
- Under Step 1, select the claims that you want to create the Corrected Claim for. Note: If you have multiple Dates of Service that were originally submitted separately, they will create multiple checkboxes. You might want to submit these as different Corrected Claims as they would most likely have unique control numbers.
- Under Step 2, change the Submission Method to Electronic (EDI). This will cause new fields to appear below.
- Select the Frequency Code that you obtained from the payer. This corresponds to Box 22 on a CMS-1500.
- Enter the Control Number obtained from the payer. This number is usually on the EOB or ERA as well.
- Select Create. A new submission will be added to your Filing Cabinet. If you selected multiple claims listed under Step 1, multiple submissions will be created.
Electronic with Original Information (Rare)
If you are not changing the information on an electronic claim, you can start at Step 3 from the above instructions. This typically occurs when you believe a payer has adjudicated the claim incorrectly.
Print & Mail - New or Original Information
- Navigate to Filing > CMS-1500.
- Locate the Print & Mail claim you need to send a Corrected Claim for.
- Click the icon and select Create Corrected Claim. A new window will display.
- Under Step 1, select the claims that you want to create the Corrected Claim for. Note: If you have multiple service lines that were originally submitted separately, they will create multiple checkboxes. You might want to submit these as different Corrected Claims as they would most likely have unique control numbers.
- Under Step 2, indicate if you would like do one of the following:
- Create claim with current information. This will update the claim for with whatever changes you have made in the system. This will also add CORRECTED CLAIM in the header of the claim form.
- Create claim without updating claim information. This will be a copy of the original claim, but with CORRECTED CLAIM in the header.
- Select Create. A new submission will be added to your Filing Cabinet. If you selected multiple claims listed under Step 1, multiple submissions will be created. If you need to add a frequency code and control number to the claim form, you must open it using a PDF Form/Large File version and manually enter the information into Box 22. You can print the CMS-1500 using the icon.
When would I use the Void Claim Frequency Code?
If you sent an electronic claim and no longer have the option to cancel it in the system, you might be able to use the Void Claim feature. For more information on how to cancel a claim, please see: Cancel/Delete a Claim.
If you have contacted the insurance company and they are unable to cancel the claim over the phone for you, you should ask if you can void the claim using a Corrected Claim. If you can, select Void Claim under the frequency code drop-down when creating an electronic Corrected Claim.