Claim Corrections and Voids
October 2023
An accurate and complete claim submission is always the goal. But sometimes you need to make a correction or retraction to a claim that you have already submitted to a payer. We’re in luck as there is a process to handle both circumstances!
A corrected claim, also known as a replacement claim, is needed when you need to correct or amend information submitted in the original claim form.
A voided claim is needed when you need to fully retract your original submission, including any payments that were issued.
Both circumstances involve citing the payer’s claim identification number within the claim form so that the payer knows the submission is intended to replace or void the original submission they already have on file. A claim must be on file and have an assigned claim number in order to submit a correction or void.
So, how do you indicate a correction/replacement or void on a claim form?
DENTAL CLAIM FORMS
ADA Dental Claim Forms do not have a designated field for corrected/replacement claims
Use Box 35 for remarks (ex. Corrected Claim# 2023123456789)
For more information and instructions on completing the current 2019 ADA Dental Claim Form visit the ADA at https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/publications/cdt/2019adadentalclaim-form_2019may.pdf
MEDICAL CLAIM FORMS
CMS 1500 Medical Claim Forms have designated fields for corrected/replacement claims
Use Box 22 for resubmission code / original ref. no.
Resubmission code, or frequency code, refers to the type of submission. The default is ‘1’ for original submission. Other common codes:
‘7’ – replacement of prior submission
‘8’ – void/cancel prior submission
Original reference number refers to the payer’s claim identification number
For more information on the CMS 1500 Medical Claim Form please read the National Uniform Claim Committee (NUCC) reference manual at https://www.nucc.org/images/stories/PDF/1500_claim_form_instruction_manual_2012_02.pdf
Is your billing staff optimizing claim submissions including corrections? Dental Billing & Consulting Professionals provides tailored consulting services to meet your specific needs. Call or text us any time at (860) 435-7344 and our initial conversation is always free of charge.