April 2, 2015

Submitting Corrected Claims

If a corrected claim (also referred to as a replacement claim) is needed, it can be submitted as follows:

• Electronically – Submitting a claim electronically will reduce the potential for the claim to deny as a duplicate. You may submit the claim electronically with the appropriate frequency code (7) and indicate in the notes/comments field the changes that are being made. Using the appropriate code will indicate that the claim is an adjustment of a previously adjudicated (approved or denied) claim. It is recommended that you document the change / correction in the Claim Note Segment - 2300, NTE01 = "ADD" and NTE02 = the correction / change to the original claim. This will ensure accurate processing of the corrected / replacement claim. If there is no detail of what needs to be changed, the claim will be withdrawn and a letter will be sent out asking the provider to resubmit the claim with appropriate notes to what the corrections should be.

• Via the Claims Inquiry Resolution Tool (CIR) on Availity.com – Learn more.

• Paper – If a corrected paper claim is submitted, it must be marked as a "corrected claim." Additionally, please include the OK Claim Review form with the claim. This form allows the provider to indicate what has been corrected on the claim. This should allow for faster processing times, as well as reduce errors due to not understanding what has been corrected from the original claim. Paper claims that are rejected will be returned to the provider with a cover letter explaining the reason for the return. Please follow the instructions on the form to properly resubmit the claim.