Claim Replace Amount Field For Free

The claim frequency codes are as follows: 1 Indicates the claim is an original claim 7 Indicates the new claim is a replacement or corrected claim ? the information present on this bill represents a complete replacement of the previously issued bill.

Box 22 is used to list the Original Reference Number for resubmitted/corrected claims. When resubmitting a claim, enter the appropriate frequency code: 6 - Corrected Claim. 7 - Replacement of Prior Claim.

On the UB-04 (CMS 1450) Form, use Box 4 (Type of Bill). Enter either "7" (corrected. claim), "5" (late charges), or "8" (void or cancel a prior claim) as the third digit in Box 4. (Type of Bill). Then in box 64 (Document Control Number), enter the original claim.

Patient Responsibility ? Key ?31? in the code box of this field to identify the value code as patient liability. Key the amount of patient minimal liability due in the Amt.

Use Resubmission Code 6 for corrected claims, Code 7 for replacements of prior claims, and Code 8 for voiding or canceling prior claims [1].

If the Member ID or Billing Provider Tax ID need to be corrected, the procedure is to VOID the original claim (using frequency code 8) and to submit a new, clean claim using the correct Member ID and/or Billing Provider Tax ID. Note: Electronic resubmissions of claims are preferred to hard-copy paper.

57 Other Provider Identifier?Billing Provider Not Required The unique provider identifier assigned by the health plan is reported in this field.

Common Re-Submission Codes Include: 6-Corrected. 7-Replacement. 8-Void.

For CMS-1500 Claim Form - Stamp Corrected Claim Billing on the claim form - Use billing code 7 in box 22 (Resubmission Code field) - Payers original claim number should also be included in box 22 under the Original Ref No. field.

It is acceptable to send void or replacement when any one split claim has reached final adjudication. previously sent or needs to be corrected. Examples include incorrect dates of service or units. To qualify for a replacement, certain identifying information must remain the same.