Reminder: Corrected Claim Request Change, Effective July 11, 2016
Posted July 22, 2016
As announced in previous communications, effective July 11, 2016, corrected claim requests for previously adjudicated claims must now be submitted as electronic replacement claims, or on the appropriate professional (CMS-1500) or institutional (UB-04) paper claim and Claim Review Form.
Electronic replacement claims should be submitted to Blue Cross and Blue Shield of Illinois (BCBSIL) with the appropriate claim frequency code. Frequency code 7 will result in BCBSIL adjudicating the original claim number (sometimes referred to as a Document Control Number, or DCN) with the corrections. The replacement claim will be issued a new BCBSIL claim number and will subsequently deny based upon the re-adjudication of the original claim.
Note: Claim corrections submitted without the appropriate frequency code will deny as a duplicate and the original BCBSIL claim number will not be adjudicated. For details on claim frequency codes, including guidelines to assist you with when and how to use them for making corrections to electronic claims submitted to BCBSIL, consult our quick reference guide.
More than 98 percent of the claims BCBSIL receives from providers are submitted electronically. BCBSIL encourages all providers to use electronic options as the primary method for claim submission. There are several multi-payer Web vendors available to providers. If you are a registered AvailityTM Web Portal user, you have access to submit direct data entry replacement claims electronically, at no additional cost.
As of July 11, 2016, any changes to a claim that are specified only on the Claim Review Form or via a letter will be returned with a notice advising resubmission on the appropriate CMS-1500 or UB-04 paper claim form. Paper claim submitters are required to indicate “corrected claim” on the paper claim form and the accompanying Claim Review Form.
For additional information on this corrected claim request change, view the answers to frequently asked questions (FAQs), The FAQs and the quick reference guide mentioned above are available in the Claim Submission section, under the Related Resources.
Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services offered by third party vendors such as Availity. If you have any questions about the products or services offered by such vendors, you should contact the vendor(s) directly.