Even small billing errors can result in claim denials, delayed reimbursement, and increased administrative work. Denial rates have increased in recent years, reaching 10%, according to TechTarget. Thus, accurate claim submission is more important than ever.
When claims are denied because of preventable errors, they must be corrected and resubmitted promptly. However, understanding how to handle corrected claims can be a fair challenge.
A corrected claim must comply with all the payer-specific requirements and billing guidelines before resubmission. Although the process appears straightforward, payer-specific requirements often make it more complicated than expected.
More importantly, much of the confusion occurs when claims are resubmitted. Why? Providers are often unsure whether a claim needs to be:
- Corrected
- Appealed
- Voided
If medical billers choose the wrong path or an inapplicable corrected claim code, they could invite a second denial.
Thus, medical billers should know:
- What a corrected claim is
- How it differs from an appeal or a void
- The resubmission codes to report
- How to submit one on CMS-1500 and UB-04 forms
- Timely filing limits
Corrected Claim vs. Appeal vs. Voided Claim
Here is a quick distinction between correct claims, appeals, and voided claims for your understanding:
Corrected Claims
A corrected claim is a replacement of a previous claim that had incorrect information, such as:
- Missing modifiers
- Incorrect CPT code or date of service
- Inaccurate patient data
Typically, such claims reference the original claim number and require a corrected claim code for resubmission.
Appeal
An appeal is also known as a redetermination or reconsideration. Appeals are used when the billing team submits a correct claim, but it is denied despite its accuracy. For instance, it may involve a bundling edit or a medical necessity error.
Unlike corrected claims, appeals do not alter the data mentioned in a claim. Instead, they are used to challenge the payer’s judgment with supporting records.
Voided Claim
A voided claim is submitted to cancel a previously processed claim because it should not have been billed. Some common triggers of claim voiding may include:
- Duplicate billing
- Wrong patient
- Wrong provider
Notably, the voided claim is completely removed from the payer’s system and isn’t limited to an information update.
| Corrected Claim | Appeal | Voided Claim | |
|---|---|---|---|
| Purpose | Fix incorrect claim data. | Dispute a payer’s decision. | Cancel a claim entirely. |
| Requires | Corrected data only. | Medical records/documentation. | Cancellation reason. |
| Common Trigger | Coding or data entry error. | Medical necessity/coverage denial. | Duplicate or wrong-patient claim. |
How to Submit a Corrected Claim?
The submission process for corrected claims may vary depending on the type of claim. However, the broader process remains the same:
- Add the reference to the original claim.
- Flag or mark it as a correction.
- Resubmit complete, corrected data.
Nonetheless, the exact submission process may differ depending on the type of claim the billing experts handle. Here’s an overview of the process:
Professional Claims (CMS-1500)
- Enter resubmission code “7” in Box 22, which indicates a replacement claim.
- Add the original claim number in the “Original Ref. No.” field of Box 22.
- Ensure all service lines plus corrections are updated as required.
- Electronically (837P), set CLM05-3 to “7” and include a REF*F8 segment with the original claim number.
Institutional Claims (UB-04)
- Start by updating the Type of Bill (Box 4). For proper submission, the third digit should read “7.”
- Use Box 64 to enter the original claim number.
- Some Medicaid and commercial payers require a copy of the remittance advice (ERA/EOB) when submitting corrected claims. Failure to include required documentation may result in claim rejection.
- Consolidate all charges, including late charges, into the single corrected claim rather than billing separately.
Important Billing Insight: Billing teams should always ensure that the claim has been completely processed before submitting a corrected claim. If a pending claim is resubmitted, it will be considered a duplicate claim and be denied.
For payer-specific requirements, refer to the applicable payer’s corrected claim submission guidelines (for example, CountyCare).
Resubmission Codes for Corrected Claims
Before resubmitting a corrected claim, it’s important to understand the applicable resubmission (frequency) codes. These are also known as claim frequency type codes or frequency codes, depending on the claim format.
However, like the submission process, the corrected claim code may also vary depending on the type of claim. Here’s what you need to remember:
CMS-1500 / 837P
For a CMS-1500 claim, medical billing teams should add the resubmission code in Box 22. Conversely, the CLM05-3 data element should be used for electronic (837P) claims. The most commonly used codes are:
- 7 = Replacement/corrected claim
- 8 = Void/cancel of a prior claim
UB-04 / 837I
For a UB-04 claim, the resubmission codes are different. Ideally, they should be reported in the third digit of the Type of Bill (Box 4). Some commonly used codes for resubmitting UB-04 claims include:
- XX7 = Replacement of prior claim
- XX8 = Void/cancel of prior claim
- XX5 = Late charges only (not for corrections)
Important Resubmission Insight: Both CMS-1500 and UB-04 claims use “7” to replace and “8” to void. However, they must be reported to different fields, depending on the type of claim a medical biller handles.
Refer to the professional claim correction guide for detailed field-by-field submission instructions for professional claims.
Corrected Claim Timely Filing Limit
The filing limit for any claim is a crucial detail that every medical biller must follow. However, the filing limits for corrected claims operate differently. Such claims have two separate clocks, which include:
- The first, or original filing limit, which is typically counted from the date the service is provided to the patient. If billers submit the claim after this limit is reached, some payers may deny the correction outright.
- Many payers establish a separate deadline for submitting corrected claims. Depending on the payer, this period may begin on the remittance date, denial date, or another date specified in the provider contract. Depending on payer policy, corrected claims may still be accepted after the original filing deadline, provided they are submitted within the payer’s correction window.
Important Resubmission Insight: Filing limits and correction deadlines may be subject to change, depending on payer, contract, and plan type. Therefore, medical billing teams must always directly verify the timelines individually.
Claim Timely Filing Limits for Various Payers
Since the claim filing limits may vary for each payer, we have compiled the filing limits for the most popular payers in this comprehensive table below:
| Payer | Original Filing Limit | Corrected Claim Window |
|---|---|---|
| Medicare (Original) | 12 months from the date of service. | Generally, within the original timely filing period. After that, CMS reopening or adjustment rules may apply. |
| Cigna | 90 days for in-network / 180 days out-of-network from date of service. | 90 days from remittance/EOB date per industry sources; Cigna’s own provider page does not publish a universal corrected-claim deadline. Thus, it may vary. |
| Humana | Varies by plan (often 90-180 days). | Typically 60-90 days from remittance date. |
| Aetna | Varies by plan. | 180 days from the date of initial denial. |
| BCBS | Varies by state plan. | Commonly 60-180 days from remittance date. |
| UHC | Commonly 90 days (commercial); 365 days for Medicare Advantage. | Commonly 90-180 days from remittance date. |
| Wellcare | Commonly 180 days from the date of service. | Tied to original filing window; verify by plan. |
| Ambetter | 180 days from the date of service and 365 days for out-of-network. | 365 days for reconsiderations; verify. |
| UMR | Commonly 90 days (plan-dependent). | Mirrors UHC window; set by employer plan document. |
| Molina | Varies by state (95-365 days). | Varies by state Medicaid contract. |
Across most payers, the rule is the same: The timely filing limit is based on the date of service for original claims. Corrected claims, on the other hand, depend on the date the original claim was processed by the payer.
However, the filing limits are different for:
- State Medicaid plans
- Self-funded employer plans
- Medicare Advantage plans
The most reliable way to verify a payer’s deadline is through its provider portal or provider services. This additional check can be highly beneficial in some cases.
For instance, in the case of a UMR claim, the filing time is determined by each employer’s self-funded plan. Thus, it does not follow a single company-wide policy.
Common Reasons Corrected Claims Get Denied
Corrected claims may be denied or rejected for various reasons, which billers who wish to reduce avoidable denials must understand. Common mistakes when submitting corrected claims include:
Treating a Rejected and Corrected Claim the Same
If a claim never entered the payer’s adjudication system and was rejected by the clearinghouse, it may require a new original submission. Therefore, it cannot be processed with a resubmission code 7.
Submissions with Claims Pending
If the billing staff submits a claim, even though the original claim is still pending, it might be rejected. In other cases, the claim may be flagged as a duplicate submission.
Incorrect or Missing Original Claim Number
Each original claim has a dedicated reference number, which must be reported with the resubmitted claim. If it is missing, the payer’s system may consider the resubmission a new claim.
Conversely, the claim may be rejected because it may be flagged as a duplicate. Both of these cases are unacceptable from a billing perspective.
Missing or Incorrect Resubmission Code
A replacement claim frequency code (7) is required for a CMS-1500 claim (or the equivalent code on the UB-04 form). If the resubmission code is missing, the payer may not consider the submission a corrected claim.
Sending an Incomplete Claim
If billers submit the corrected claim line only and not the complete claim, it may be rejected. This is because the payer may not be able to evaluate the adjustment, hindering the process.
Missing Required Supporting Documentation
The documentation requirements vary for each payer. However, several payers require the original Explanation of Payment (EOP) or additional documentation for processing institutional corrections. If the resubmission doesn’t include them, the claim will be denied.
Missing the Submission Deadline
The filing windows for corrected claims are generally shorter and depend on the remittance date, not the date of service. Missing these deadlines may result in a permanent denial and revenue loss.
Following the Wrong Filing Steps
Following the appropriate resubmission workflow while handling resubmissions is necessary. You should check:
- Whether a correction is appropriate
- Filing limit
- Claim identifiers/codes
- Complete submission
- Documentation
Best Practices for Resubmission of Corrected Claims
Resubmitting claims that have been corrected may seem challenging. However, the following best practices ensure a smoother resubmission process.
- Confirm the original claim status and exact claim number before resubmitting. Billers should avoid rebilling processed claims unless they have a valid correction, as this will prevent delays and admin burnout.
- Use the correct resubmission code and enter it in the appropriate form field.
- Include required documentation upfront to reduce rejections.
- Record the correction reason internally to support follow-up, audits, or payer questions.
- Track each resubmission through resolution, separate corrected claims from original submissions, and follow up on delayed remittances.
- Maintain a payer-specific checklist for billing staff to standardize resubmission rules and documentation requirements.
Summing It Up
Corrected claims rectify genuine errors without endangering reimbursement. However, they must be submitted with the accurate:
- Reference number
- Resubmission code
- Filing deadline
Following these steps ensures your claims bring:
- Faster reimbursements
- Fewer denials
- Cleaner A/R
However, if your in-house team needs assistance with maintaining claims accuracy, our medical billing services include end-to-end resubmission management.
