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Corrected Claim Handling Update for Medicaid Members

Posted January 16, 2020

Corrected claims are electronic claims submitted with frequency code 7 or paper claim submissions where the claim form is marked as corrected.

On Dec. 14, 2019, as of 1 p.m., CT, Blue Cross and Blue Shield of Illinois (BCBSIL) updated the way corrected claims are processed for our Medicaid members. This includes members with the following benefit plans: Blue Cross Community Health PlansSM (BCCHPSM) and Blue Cross Community Medicare-Medicaid Plan (MMAI)SM. This change was made to help prevent unnecessary recoupment activity by stopping the complete reversal of the claim being corrected. Instead, adjudication of the corrected claim will reflect the difference between the original and the corrected allowable.

There was one issue related to implementation of the change referenced above. As you may be aware, the 277CA response generates new claim numbers for corrected claims. Please note that new claim numbers were generated with no change from prior handling and format for MMAI and BCCHP corrected claims received Dec. 14, 2019, through Jan. 2, 2020, but the corrected claim numbers generated during this period will not be searchable for further status updates.

Here are instructions for checking status for corrected claims affected by this issue:

  • To check status of corrected claims for Medicaid members received Dec. 14, 2019, through Jan. 2, 2020, you may use the Subscriber ID and Date of Service (DOS)
  • If checking claim status using an online format (such as the Claim Status Tool for government programs), leave the claim number field blank for corrected claims received during this period.

The above issue was resolved for corrected claims received as of Jan. 3, 2019. At this time, you may use the claim number generated on the 277CA response to search for and obtain status on corrected claim submissions for MMAI and BCCHP members.