Corrected/Replacement Claims - How to Create & Submit

Mistakes happen, and you may need to send a replacement claim. ChiroSpring provides two options to do this.

• Free Option - Do it Yourself
• Service Center - $5.75/claim

The first thing to understand is that there is a difference between correcting & resubmitting a claim that has not been adjudicated vs. correcting a claim that has been adjudicated (submitted and returned) and then denied or rejected. CLICK HERE for a detailed explanation on the difference.

If the claim has not been adjudicated by the payer but denied or rejected, those claims will be Pink and you will find them in your Rejected Folder. From there - you can send the claim back to Pending, make your corrections and resubmit the clam. CLICK HERE for steps on resubmitting a non-corrected claim.

Now that you have identified you do in fact need to correct the claim and submit a replacement there are two options for you to consider.

Free Option - Do it yourself - This is the preferred option for most customers as it is free and "do it yourself". With this option, you correct the claim, drop Box 22 to "Replacement" , add the ICN and resubmit through EDI (electronically) or by printing the claim to paper. Note, this option is not free for legacy plans.

Pay Us - ChiroSpring Service Center/Add Request (under PT avatar) - With this option, you are requesting our team to locate the ICN number and complete the Replacement Claim. You will still need to fix the claim in office, but ChiroSpring does the work after that. This option has a cost. You can find the cost under your subscription plan for "Replacement Claim".

Step 1: Find and Edit the Claim

The first step for a correction/replacement claim is to edit and fix the claim. The best place to find rejected claims is in the Rejected Claim Folder (located under Billing/Claim Folder/Rejected).

You can also find claims in Pending Claims or Claim History. In any case, edit the claim by clicking the pencil icon.

• Choose "Save Claim" from the options displayed (bottom right action button). This action reopens the claim, enabling you to make necessary changes.

Step 2: Make Changes to the Claim

1. Now that the claim is editable you may change any available field.
2. To edit services, click the pencil icon. You may also remove or add services using the respective + or trashcan icons. Once Box 24 has been corrected, click on "Update" to save your changes.
3. If it a Patient ID/demographics issue, that can be corrected in the Insurance Information and then re-selected on the claim.

Step 3: Find the ICN for Box 22

The Internal Control Number (ICN) is required in Box 22 for the claim you want to correct and resubmit. This is the claim number the payer had assigned to your claim.

• Go to Reports/Claims & Products/ERA
• Run the ERA report
• Locate the ERA and click the eyeball icon to see details (see below). Locate the ICN number as shown below.
• If you received a paper EOB, the ICN will read "claim number" and will be in the PT information area at the top.
• Highlight the ICN number and COPY (control C on PC or command C on Mac)

Step 4: Populate Box 22

Populate Box 22. Choose "Replacement" from the dropdown and paste the ICN number in the box.

Step 5: Save and Submit the Claim

Once the claim has been fixed and Box 22 has been filled out, you can Save Claim to save your changes. You can submit to us, create your own EDI file to upload or print the claim.

• Submit to ChiroSpring: From the pending claim folder, select claim and submit to ChiroSpring
• Submit EDI: Click the Action button and choose choose Generate EDI - then save locally and upload into your clearinghouse.
• Print the claim: Click the Action button. Choose Generate CMS or Submit Paper. Once you have submitted, select "Complete Submission" to change the claim status to complete.

Please note that while we provide instructions for the do-it-yourself option in ChiroSpring 360 to request a replacement claim, we are not responsible for any issues, rejections, or failures that may occur during the process. It is recommended to exercise caution and ensure accuracy when making changes to your claims.

Some customers prefer this option as our team is performing the work to find the ICN number for you. There is a cost for this service.

Step 1: Locate the Claim Needing Correction

1. Once you're logged in, find the claim that requires correction. This could be in your claim history or pending claim folder.

Step 2: Open Claim for editing

1. Click on the action button associated with the claim that needs correction.
2. From the options displayed, select "Save Claim." This action reopens the claim, allowing you to make necessary changes.

Step 3: Make Changes to Line Items

1. Locate the pencil icon within the claim and click on it.
2. Modify the line items as needed to correct any errors or update relevant information.

Step 4: Update the Claim

1. After making the necessary changes, click on the "Update" button to save your modifications.

Step 5: Save and Submit the Claim

1. Click on the action button again.
2. Select "Save Claim" to save your changes.
3. Click on the action button once more, and this time, choose "Replacement Claim." This action will automatically submit your corrected claim.

Once you've successfully requested a replacement claim, follow the steps below to handle it within the pending claims folder, to avoid duplicate submissions, ensure that you complete the claim after requesting a replacement. This step is crucial to prevent the claim from being submitted twice.

Step 6: Complete the Replacement Claim

1. Access your pending claims folder.
2. Checkbox the claim that you need to complete.
3. Choose "Complete Claim" from the action button.