Reminder: Corrected Claims

After submitting a claim to BlueCross BlueShield of South Carolina, you may notice that a change is needed.  In this instance, you will need to submit a corrected claim for processing.  As a reminder, it is important to submit corrected claims properly to avoid receiving a duplicate denial due to the previous claim having already been filed.

To properly submit a corrected claim, the following four items are needed:

  1. Frequency Code 7 (indicating an adjustment) should be placed in Box 22 of the CMS-1500 form (Resubmission Code). 

This corresponds to the CLM05-3 segment in the 2300 Loop of the electronic claim file.

  1. The BlueCross original claim number (“ICN” or “DCN”) should be placed in Box 22 of the CMS-1500 form (Original Ref. No.). 

This corresponds to an REF segment with an F8 qualifier in the 2300 Loop of the electronic claim file.

  1. A brief description for the reason of the adjustment (e.g., new service line, added modifier, etc.) should be placed in Box 19 of the CMS-1500 form (Additional Claim Information). 

This corresponds to an NTE segment in the 2300 Loop of the electronic claim file.

  1. ALL claim lines that need to be processed, including existing lines, corrected lines, or additional lines.

 

If filing a corrected claim through My Insurance Manager℠ (MIM), do the following:

  1. Under the Patient Care menu, select Professional Claim Entry.
  2. Select a plan and indicate whether the plan is the primary payer.
  3. Select the billing location, rendering provider and/or referring provider when prompted.  You can opt to choose a patient or manually enter the patient’s information on the Patient Information page.
  4. On the Claim Information page, select Replacement of Prior Claim from the Claim Type menu.  Enter the prior claim number in the required filed.
  5. Enter the new information from the line of your claim.
  6. Include ALL lines that need to be processed, including existing lines, corrected lines, or additional lines.
  7. Once completed, select Continue.
  8. Confirm the claim information is accurate, then click Submit.

If you have any questions, be sure to contact Provider Education using the Provider Education Contact Form located on www.BlueChoiceSC.com.