Box 22 Resubmission Code/Original Ref. No.

What is it?

Box 22 is used to list the Original Reference Number for resubmitted/corrected claims. When resubmitting a claim, enter the appropriate frequency code:

• 6 - Corrected Claim
• 7 - Replacement of Prior Claim 
• 8 - Void/Cancel Prior Claim 

The Original Reference Number is assigned by the destination payer or receiver to indicate a previously submitted claim or encounter. This is also known as the Claim Reference Number or ICN.

This box is not intended for use with original claim submissions. 

In Application:

For more information on how to populate this field, please see: Filing a Corrected Claim.

EDI File

Resubmission Code

• Loop 2300, Segment CLM05-3 (A value of 1 indicates Original Claim)

Original Ref. No.

• Loop 2300, Segment REF02 (if REF01 is F8)