Resubmission vs Corrected/Replacement Claims

There may be times when you need to resubmit a claim. First you should determine if this is a simple resubmission, or if the claim requires populating Box 22 (for corrected/replacement claims).

Resubmission: A resubmission is required when the claim has been Rejected at the clearinghouse or payer level. These will sit in you "Rejected" claim folder and will have the PINK dot by them.

• Clearinghouse Rejection: The claim never made it to the payer. The clearinghouse found an error on the claim before transferring it to the payer. 

• Payer Rejection: The payer found an error and rejected before it was entered into their system for adjudication. They did not process the claim and therefore the claim can be resubmitted.

Either of these rejections can be corrected and the claim can be submitted as a new or "clean" claim. You will not need to populate Box 22 as this claim was never denied (it was only rejected).

STEPS TO RESUBMIT A CLAIM

Replacement: A replacement claim (sometimes referred to as a corrected claim) is required when the claim has reached the payer and has been adjudicated (processed) but one or more lines have been denied for an error. This claim will need to be "Replaced" (corrected) You can follow along how to do that in this article:

STEPS TO SUBMIT A REPLACEMENT CLAIM

Please note: Medicare as well as WC/PI payers do not accept replacement/corrected claims - You can correct the claim and resubmit as a new claim. If a paper corrected claim is needed for WC/PI, please request in the Service Center under the patient in "Add Request" or you can print out in office and add the header "Paper Corrected Claim" on the top left hand side of the CMS 1500.