Filing a Corrected Claim

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.

Creating a Corrected Claim

Electronic Corrected Claim

After the changes have been made to the client/session, ensure it is in the Bill Insurance queue (Billing>Billing Insurance page). This can be done by selecting Resubmit or Send to the insurance invoice area when posting a payment. For more information, please see: Send To Insurance Invoice Area

1. Go to Billing > Bill Insurance. 
   
2. Click on Select Client. If needed, adjust the DOS Range on the right, then select the lines of services to be submitted. Click Create Invoice.
3. Under the Submit Claim section, select the PDF icon for Print & Mail Claim. This will create a new version of the claim in the system which will be under Filing > CMS-1500 to use this claim to file a corrected claim.
   Note: A pop-up window will appear, which allows you to choose a PDF version to print and mail a claim. You will need to close out of this window.
    
4. Next, go to Filing > CMS-1500 and locate the claim.
   
5. Select the  icon and click Create Corrected Claim. A new window will be displayed.
6. Under Step 1, select the claims that you want to create the Corrected Claim for. 
   Note: Multiple Dates of Service that were originally submitted separately will create multiple claims. You will need to submit these as separate Corrected Claims, go back to the original claim, and select Claim: 2 under Step 1.
7. Under Step 2, change the Submission Method to Electronic (EDI). This will cause new fields to appear.
   
   1. Select the Frequency Code that you obtained from the payer. This corresponds to Box 22 on a CMS-1500. Note: The majority of insurances require the Replace submitted claim [7] Frequency Code.
      
   2. Enter the Control Number obtained from the payer. This number is usually listed as the claim number or payer reference number on the EOB or ERA.
8. Select Create. A new submission will be added to your Filing Cabinet. Multiple submissions will be created if you select multiple claims listed under Step 1.

Printed Mail Corrected Claims

Follow the steps below on how to create a Printed Mail Corrected Claim.

After the changes have been made to the client/session, ensure it is in the Bill Insurance queue (Billing>Billing Insurance page). This can be done by selecting Resubmit or Send to the insurance invoice area when posting a payment. For more information, please see: Send To Insurance Invoice Area

1. Go to Billing > Bill Insurance. 
   
2. Click on Select Client. If needed, adjust the DOS Range on the right, then select the lines of services to be submitted. Click Create Invoice.
3. Under the Submit Claim section, select the PDF icon for Print & Mail Claim. This will create a new version of the claim in the system and will be under Filing > CMS-1500 to use this claim to file a corrected claim.
   Note: A pop-up window will appear, which will allow you to choose a PDF version to print and mail a claim. You will need to close out of this window.
4. Next, go to Filing > CMS-1500.
   
5. Locate the Print & Mail claim you need to send a Corrected Claim for.
6. Click the  icon and select Create Corrected Claim. A new window will display. 
   1. 1. Under Step 1, select the claims that you want to create the Corrected Claim for.
         
         Note: Multiple Dates of Service that were originally submitted separately, will create multiple claims. You will need to submit these as separate Corrected Claims, go back to the original claim and select Claim: 2 under Step 1.
      2. Under Step 2, indicate if you would like to do one of the following:
         1. 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.
         2. Create claim without updating claim information (rare). This will be a copy of the original claim, but with CORRECTED CLAIM in the header.
   2. Select Create. A new submission will be added to your Filing Cabinet. If you select multiple claims listed under Step 1, multiple submissions will be created.
      
      Note: 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 PDF 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.