Can providers submit corrected claims electronically?
Providers can submit corrected claims electronically using the 837 format, but there are very specific rules for doing so, i.e., required by the 837 format, and outlined in our EDI Claims Companion Guide on pages 15 and 16. Basically, corrected claims are submitted electronically as “replacement claims,” which have frequency codes of 7. UB-04 submitters are familiar with frequency codes from Form Locator 4, but frequency codes are new to CMS-1500 submitters with the introduction of the 837P electronic file. A replacement claim asks the insurance company to take a specified claim received earlier and replace it with newly submitted information. Corrected claims must meet additional criteria to be accepted: they must include an original BMC HealthNet Plan claim number in a finalized status, and the member ID and NPI must be the same on the corrected claim and the original claim.
