There are times when you may need to resubmit a claim that has already been processed. These are considered corrected claims, and they may be needed if the claim is denied, if there was a mistake on the first submission, or if the claim wasn’t properly adjudicated upon the first submission.
In this guide, we’ll cover:
Things to consider when submitting a corrected claim
We always recommend contacting an insurance payer before submitting a corrected claim, as payers can have unique rules/requirements for submitting corrected claims. For example, Medicare typically doesn't accept resubmissions and asks that all claims, even corrected claims, are submitted as originals.
When contacting a payer, provide them with the client’s insurance ID, the date(s) of service on the claim, and the billed amount so they can locate it in their system and advise accordingly.
Here are some examples of when to contact a payer regarding a corrected claim:
- If a claim was denied
- If you noticed an error on the claim shortly after it was submitted
- If the claim wasn’t processed correctly by the insurance payer
Claims that are rejected due to invalid/missing information shouldn’t be resubmitted as a corrected claim. These claims are rejected prior to the payer processing them and can instead be deleted, recreated and submitted.
To submit a corrected claim, you’ll need the payer claim number of the original claim. If you’re enrolled to receive electronic Payment Reports (ERAs), the payer claim number can be found at the top of the claim and in the claim details.
If you’re not enrolled to receive Payment Reports, the payer claim number can be found on the Explanation of Benefits (EOB). This number can also be retrieved from the payer directly.
How to submit a corrected claim
Each time a claim is submitted electronically, it has backend data tied to it. As a result, processing issues can occur if you manually edit and resubmit a claim. Instead, you’ll want to delete the original claim, create, and submit a new one as a corrected claim.
Important: Make the necessary corrections to the appointment and/or the client’s insurance information before following the steps below.
To do this:
- Locate the claim in your Claims tab or in the client's Overview > Billing page
- Open the original claim
- Take note of both the clearinghouse reference number and payer claim number
- Download the claim
- Click the trash icon at the top of the screen to delete the claim
- Return to your Unbilled appointments page and click Create claims to make a new claim for the date(s) of service
Important: Make sure to choose Create claims, as you'll be able to edit the newly created claim before submitting it.
Once you've created a new claim:
- Open the new claim in your Claims tab
- Click Edit at the top of the claim
- Scroll down to Box 22
- Make sure that Resubmission (7) is selected
- Enter the original claim's payer claim number (not the clearinghouse reference number) in the Original ref. no. field
- Click Save and submit the claim to the payer
For additional information, see Using claim reference numbers.