Blue Review
A newsletter for physician, professional, facility, ancillary and Medicaid providers

August 2016

Reminder: Corrected Claim Request Change, Effective July 11, 2016

As a reminder, effective July 11, 2016, corrected claim requests for previously adjudicated claims must be submitted as electronic replacement claims, or on the appropriate professional (CMS-1500) or institutional (UB-04) paper claim, and Claim Review form.

Electronic Submission
Electronic replacement claims should be submitted with the appropriate claim frequency code. Frequency code 7 will result in Blue Cross and Blue Shield of Texas (BCBSTX) adjudicating the original claim number (sometimes referred to as a Document Control Number, or DCN) with the corrections. The replacement claim will be issued a new BCBSTX claim number and subsequently deny based on the re-adjudication of the original claim.

Note: Claim corrections submitted without the appropriate frequency code will deny as a duplicate and the original BCBSTX claim number will not be adjudicated. See below for additional information on claim frequency codes and guidelines to assist you with when and how to use them for making corrections to electronic claims submitted to BCBSTX.

Claim Frequency Codes
Code Description Filing Guidelines Action
5 Late Charge(s) Use to submit additional charges for the same date(s) of service as a previous claim. File electronically, as usual. Include only the additional late charges that were not included on the original claim. BCBSTX will add the late charges to the previously processed claim.
7 Replacement of Prior Claim Use to replace an entire claim (all but identity information). File electronically, as usual. File the claim in its entirety, including all services for which you are requesting reconsideration. BCBSTX will replace the original claim with corrections and the replacement claim will be denied. Refer to the original claim for adjudication.
8 Void/Cancel of Prior Claim Use to entirely eliminate a previously submitted claim for a specific provider, patient, insured and "statement covers period." File electronically, as usual. Include all charges that were on the original claim. BCBSTX will void the original claim from records, based on request.

Paper Submitters

More than 98 percent of the claims BCBSTX receives from providers are submitted electronically. BCBSTX encourages all providers to use electronic options as the primary method for claim submission. There are several multi-payer web vendors available to providers. If you are a registered Availity® web portal user, you have access to submit direct data entry replacement claims electronically, at no additional cost

As of July 11, 2016, any changes to a claim that are specified only on the Claim Review form (or via a letter) will be returned with a notice advising resubmission on the appropriate CMS-1500 or UB-04 paper claim form. Paper claim submitters are required to indicate “corrected claim” on the paper claim form and the accompanying Claim Review form.