To help expedite your claim review requests submitted through the Claim Investigation transaction on the NaviNet^® web portal, we would like to remind providers that claim edits and claim corrections are not permitted. If you need to edit a claim, a corrected claim must be submitted with the new information, and you need to note the original claim number on the corrected claim.

Corrected claims

The term ?corrected claim? is meant for corrections to claims that were processed and finalized in the adjudication system and for which a claim number was assigned, but the provider wishes to have the following performed on the original claim:

• replacement of prior claim (correction of the charges/services originally submitted by the provider);
• void/cancellation of prior claim (reflecting the elimination of a previous claim in its entirety);
• add late charges to an inpatient claim after the original claim was processed.

The corrected claim must be submitted under the same National Provider Identifier (NPI) as the original claim. If a claim was originally submitted under the wrong NPI, you must then submit a void request for the original claim number. Once the claim has been voided, you can submit a new claim under the correct NPI.

Providers must follow the instructions detailed in the following sections to ensure their corrected claims are accurately processed in a timely manner.

NaviNet 1500 Claim Submission transaction

Providers may submit certain corrected claims through the 1500 Claim Submission transaction. The Claim Submission transaction can be used to expedite local professional corrected claims with a frequency code: 7 = Replacement of prior claim.

When using Claim Frequency Type Code 7 (Replacement of prior claim) or 8 (Void/cancellation of prior claim), the provider must complete the Original Claim Number field.

A notes field is available in the Remarks section of the 1500 Claim Submission ? Header to provide a detailed description.

For further instructions on how to use the 1500 Claim Submission transaction, please read the Claim Submission Guide, which can be found in the NaviNet Resources section.

Paper claims

CMS-1500 claim form

Box 22 ? Resubmission and/or Original Reference Number
Follow the instructions from the National Uniform Coding Committee (NUCC) billing requirements:

• List the original reference number for resubmitted claims.
• When submitting a claim, enter the appropriate resubmission code in the left-hand side of the field.
• – 7 = Replacement of prior claim
• – 8 = Void/cancellation of prior claim

Example:

For more information, please refer to the 1500 Health Insurance Claim Form Reference Instruction Manual, which is available under the 1500 Claim Form tab on the NUCC website.

UB-04 claim form

Field location 4 ? Type of Bill ? Frequency Code

When submitting a claim, enter the appropriate Frequency Code in the fourth position of the Type of Bill:

• 5 = Late Charge(s) only
• 7 = Replacement of prior claim
• 8 = Void/cancellation of prior claim

Field location 64 ? Document Control Number

This field is used to capture the original reference/claim number, which is required for corrected claims.

Electronic claims

As a reminder, there are specific guidelines in the AmeriHealth versions of the HIPAA Transaction Standard Companion Guide that providers must follow when resubmitting a claim for an adjustment. In order for the adjustment to occur, the following Loop ID/Reference segments must be populated accordingly:

• Loop ID: 2300, Reference: CLM05-3 (Claim Frequency Type Code);
• If CLM05-3 contains 5 (Late Charge(s) ? institutional only), 7, or 8, prior claim information is required. The following segments are required in Loop 2300:
• – REF – Payer Claim Control Number (REF01 = F8 and AmeriHealth Claim Number in REF02)
• – NTE – Billing Note (NTE01 = ADD and detailed description regarding the adjustment in NTE02)

Claim resubmission

Claim Frequency Type Codes that tie to a "prior claim" or "finalized claim" refer to a previous claim that has completed processing in the payer's system and has produced a final paper/electronic Provider Explanation of Benefits (professional) or Provider Remittance (facility).

Please note the following:

• Previous claims that are pending due to a request from the payer for additional information are not considered a "prior claim" or "finalized claim.?
• An 837 professional claim transaction is not an appropriate response to a payer's request for additional information. Rather, providers must follow the instructions within the request for returning the additional information. At this time, there is no EDI transaction available to return the requested information.
• Claims submissions due to previously submitted claims that were rejected/denied are not considered ?corrected claims.?
• When submitting ?corrected claims,? please be sure to include all services originally billed and not just the service that needs correction.

For more information about electronic claim submission guidelines, refer to the appropriate HIPAA Transaction Standard Companion Guide for AmeriHealth New Jersey or AmeriHealth Pennsylvania, available on the Trading Partner Business Center.

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