How to Submit a Corrected Claim
A corrected claim is a resubmission of a previously processed claim that requires changes such as:
- Missing information – Missing essential data from the original submission, such as a procedure code.
- Typographical errors – Incorrect name spelling, policy number, or patient demographics.
- Incorrect information – Wrong procedure code, diagnosis code, or date of service.
- Billing errors – Inaccurate procedure codes or billing amounts.
Corrected Claim Submission Requirements:
- Submit the claim with all line items included, not only the corrected line(s).
- Include appropriate bill frequency code or claim frequency type code to indicate if the claim is a replacement or correction.
- Reference the original claim number in the appropriate field based on claim form type.
- Submit within 365 days of the last processed claim determination date.
- Send directly to PGBA. Do not send through the reconsideration process.
| Required Field | EDI Claim | Paper Claim Form |
|---|---|---|
| Frequency Code | 2300 CLM05-3 = ‘7’ | UB-04 FL 4 |
| Original claim number | 2300 REF*F8 segment | UB-04 FL 64 CMS-1500 Box 22 |
Helpful Reminders:
- Allow appropriate processing time before resubmitting claims. Do not submit a corrected claim if the original claim is in process.
- Review remittance advice messages to determine whether correction or reconsideration submission is appropriate.
- Do not submit duplicate original claims for claim corrections.