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Submitting Corrected Claims

A corrected claim is a replacement of a previously submitted claim. Previously submitted claims that were completely rejected or denied should be sent as a new claim

Electronic submission

Providers who submit claims through electronic data interchange (EDI) should submit corrected claims via EDI in the HIPAA-compliant 837 format. Use the following coding:

  • Loop 2300
  • Segment CLM05-3 = 7
  • Segment REF01 = F8
  • Segment REF02 = the 13-digit original claim number (no dashes or spaces)

Paper submission

Providers who submit paper claims can use XPressClaim® to submit corrections.

  • For professional claims, select "7-Replacement of Prior Claim" as the claim type and enter the original claim number (no dashes or spaces) in the Prior Claim Number field.
  • For institutional claims, select "7-Replacement of Prior Claim" as the claim frequency and enter the original claim number in the Payer Claim Control Number field.

Corrected claims with attachments

Corrected claims with supporting documentation, such as an Explanation of Benefits (EOB) or Certificate of Medical Necessity (CMN), can be sent electronically, even if the original submission was via paper.  

To expedite claims processing, use the “Upload Documents" feature on our secure portal. From the drop-down menu, choose "Corrected Claim" as the document type. 

Claims with supporting documentation include:

  • claims for patients who have other health insurance (OHI) and you need to include the OHI EOB
  • claims with medical documentation
  • claims with a CMN
  • claims with possible third party liability (TPL) and you need to include the patient-signed DD Form 2527 TPL form 

Learn more on our XPressClaim page. 

 

 

 

 

XPressClaim® is registered trademark of PGBA, LLC.