Should you file a corrected claim?
There are a variety of reasons behind resending a claim to an insurance company. Here, we are using the term 'resend' to be ambiguous. In general, these 'resends' are classified as either resubmissions or corrected claims. Whether you are going to resubmit a claim or file a corrected claim usually depends on how the insurance company handled your first submission. That is, did they reject it or did they deny it (Please see: claim rejection versus claim denial).
Therabill is not going to tell you when you need to file a corrected claim. To truly know if you need to file a corrected claim versus resubmitting the claim, you should call the insurance company and ask them. In general, a corrected claim is filed when the insurance company has adjudicated your original claim and denied it. You normally resubmit a claim (a new claim submission) when the payer rejected your original claim. For information on rejections versus denials, please see: claim rejection vs claim denial.
When you are on the phone with the payer and they tell you that you need to file a corrected claim (instead of simply resubmitting the claim), then get the details of how they want a corrected claim filed. Below is a guideline for how you might approach this.
Question A: Can I correct my claim over the phone?
If Yes to Question A:
Awesome. Give them the corrections over the phone and keep your eye out for the adjudication results on an Explanation of Benefits or Electronic Remittance Advice.
If No to Question A:
Question B: Do they accept electronic submission of a corrected claim or does it need to be done by paper claim?
If Yes to Question B
Question C: What Frequency Code do you expect on the EDI submission of the corrected claim. Some insurance companies want Code: 6 for corrected claim, others want Code: 7 for replacement of submitted claim.
Question D: What is the Control Number to submit on the EDI submission of the corrected claim. The control number is the code that they will use to match this submission to the original submission. This number can often be found on the ERA or EOB as the payer reference number or payer claim number. However, you will want to verify with the payer what number they want sent over.
If No to Question B
Question E: On the print corrected claim, how do you want the claim created. That is, do you want a new copy of the claim with the new information or do you want an original copy with edits written in? Get as much information as possible.
Based on the questions and answers above, you now have enough information on 1.) whether or not you can use Therabill's corrected claim feature and 2.) how to use Therabill's corrected claim feature to create the corrected claim to their specifications.
Creating the corrected claim
NOTE: Before creating the corrected claim, you will want to make any fixes to the client or session information. For example, if there is a problem with the diagnosis codes or diagnosis pointers, you will want to correct that issue first, then create the corrected claim. See the following article for more information on Adding Both ICD-9 and ICD-10 Treatment Diagnosis Codes.
Filing a corrected claim in Therabill is done through the filing cabinet. Click Filing in the top green navigation bar of Therabill. You should now be at your CMS-1500 filing cabinet. Find the submission that you want to file a corrected claim on. Use the variety of search filters at the top to help you find the submission. Once you have located the submission, click the tools icon associated with that submission. In the menu that opens, click the Corrected Claim or Void Claim option. You will now see a form similar to the image shown at the right.
Step one will be to choose which claims from your submission you'd like to create a corrected claim for.
The form has two main submission methods for the corrected claim. The two methods are
- Method 1: Electronic
- Method 2: Paper (Print & Mail)
The method you go with depends on the answer to Question C above.
To indicate that you want to submit the corrected claim electronically, select "Electronic (EDI)" from the submission method dropdown menu.
NOTE: Electronic submission of corrected claims is not always the best route. Through experience, Therabill has found that many insurance companies are 'buggy' when it comes to electronic submission of corrected claims. Therabill recommends paper corrected claims as a more robust method.
- Frequency Code: Choose the frequency code from the drop down list that they gave you in Question D above.
- Control Number: Enter the control number that they gave you in Question E above.
IMPORTANT: The frequency code and the control number are very important. Please do not think that you can enter whatever you want as the control number. We see this a lot, the control number is a specific code that they payer will use to match your corrected claim submission to a previous submission (the submission that you are correcting).
To submit your corrected claim by paper, choose one of the options within the paper submission method. IMPORTANT: When Therabill creates the paper corrected claim, it will put CORRECTED CLAIM across the top right of the CMS-1500 claim form.
- Create claim with current information: This will create a new CMS-1500 filled in with the current information that you have entered for your client, providers, sessions etc. in Therabill. The CMS-1500 will have CORRECTED CLAIM written across the top right of the CMS-1500.
- Create claim without updating: This will print out a copy of the claim as it was originally submitted (it will have CORRECTED CLAIM) written across the top right of the CMS-1500. This option is often used when the payer wants you to send them an original copy with manual edits (for example, using a pen to manually change information).
To create the corrected claim, click the Create button at the bottom of the form.
On paper corrected claims, if you need to enter a resubmit code and control number, open the PDF/Large File form of the claim, and enter the control number and resubmission code into box 22 before printing.
Back in your Filing Cabinet
The corrected claim will be listed as a new entry/ submission in your filing cabinet, with a unique Claim ID number.
What should I do now?
You will want to follow the same process as you would when you create a new claim. Make sure the claim is going through. If you filed the corrected claim electronically, it is a good idea to call the payer in a few days to make sure they received and are processing it (electronic corrected claims are notoriously mishandled by the payer).