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When to submit a corrected claim in SimplePractice and how

When to submit a corrected claim in SimplePractice and how

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

It’s always recommended to contact an insurance payer before submitting a corrected claim, because payers can have unique rules/requirements to submitting corrected claims. State Medicare payers, for example, typically don't accept resubmissions and want all claims 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 insurer

In general, a claim that was rejected due to invalid/missing information should not be resubmitted as a corrected claim. These claims are rejected prior to the payer processing them.

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

When a claim is submitted electronically, it has backend data tied to it. This can cause processing issues if you manually edit and resubmit a claim. Instead, you’ll need to delete the original claim, and create and submit a new one as a corrected claim. Here’s how:

Important: Make the necessary corrections to the appointment and/or the client’s insurance information before following these steps.

  • Open the original claim
  • Download a copy
  • Save both the clearinghouse reference number and payer claim number

claim_clearinghousenumber.simplepractice.claims.png

  • Delete the claim
  • Return to your Unbilled appointments page and create a new claim for the date(s) of service in question

Important: Make sure to choose Create claims, not Create and submit claims. The newly created claim will need to be edited before submission. 

createclaims.simplepractice.unbilledappointments.png

  • Open the new claim in your Claims tab
  • Click Edit at the top of the claim
  • Scroll down to Box 22, mark it as a Resubmission (7) and enter the original claim's payer claim number (not the clearinghouse reference number)

originalrefnumber.simplepractice.claims.png

Note: When submitting a corrected claim by paper, payers will ask that you include a resubmission code (7). When submitting a claim electronically, this is automatically included as long as the Resubmission (7) option is selected. 

  • Click Save and submit the claim to the payer

For additional information, see: Payer Claim # vs. Clearinghouse Reference #.

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