How to handle Corrected/Replacement Claims

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

1. ChiroSpring Service Center - With this option, you are requesting our team to locate the ICN number and internally place the resubmission code 7 creating the replacement claim This option has a cost. You can find the cost under your subscription plan for "Replacement Claim".

2. Do it yourself Option - This option is ONLY available for Paper Corrected/Resubmissions.  With this option, you correct the claim, populate Box 22, and generate CMS or submit paper for paper claim submission. This is a manual process and is preferred by most as there is no added cost.

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.

This is the free option and preferred option by most. Follow the steps below to create a PAPER (electronic is not supported with the do-it-yourself option) replacement claim.

NOTE: We are working on adding an electronic do-it-yourself option soon. 😊

Step 1: Locate the Claim Needing Correction

1. Log in to your ChiroSpring 360 account.
2. Find the claim that requires correction in either your claim history or pending claim folder.

Step 2: Open the claim for editing

1. Identify the action button associated with the claim that needs correction.
2. Click on the action button.
3. Choose "Save Claim" from the options displayed. This action reopens the claim, enabling you to make necessary changes.

Step 3: Make Changes to the Claim

1. Within the claim, locate the pencil icon.
2. Click on the pencil icon to enter the editing mode.
3. Modify the line items as needed, correcting any errors or updating relevant information.

Step 4: Update the Claim

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

Step 5: Locate the ICN number

1. Access the ERA (Electronic Remittance Advice) report details.
2. Find the Internal Control Number (ICN) associated with the claim.
3. Copy the ICN

Step 6: Add Resubmission Code and ICN number

1. In the original reference number segment of the claim, locate box 22
2. Paste the ICN (Internal Control Number) into box 22.
3. Ensure that a "7" is included as the resubmission code in box 22

*This code signifies that the claim is a replacement claim for a corrected claim.

Step 7: Save and Submit the Claim

1. After making all the necessary changes, click on the "Update" button to save your modifications.
2. Click on the action button once more.
3. Select "Save Claim" to save your changes.
4. From the pending claim folder, select claim and choose Generate CMS, or Submit Paper
5. After printing the claim, click the Action button. Then 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.