Corrected Claims Filing Requirements Reminder

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) would like to remind providers that when filing corrected claims, coding guidelines require specific data elements. Claims are only eligible to be considered as corrected claims when they are resubmitted after being previously processed for payment.  

Each month, Blue Cross NC receives a large volume of corrected claims that have not been filed appropriately. When providers do not file corrected claims with the appropriate frequency or type of bill code, claims must be returned or manually researched which creates delays in providers receiving their reimbursement, and additional administrative tasks and resources are spent trying to resolve many corrected claims.     

Effective 08-01-2023 Blue Cross NC will begin rejecting corrected claims submissions, and these claims will be mailed back regardless of whether the claim was filed electronically or on paper, for the following three scenarios:  

1. When the original claim ID number submitted cannot be located in our claims processing system. Resubmit as an original claim or validate the corrected claim you submitted has the correct original claim ID number.    
2. When the original claim form type submitted is the incorrect claim form type and needs to be corrected.  You must first void the original claim submission and resubmit a new claim using the correct form type i.e., provider submits an original claim on a CMS-1500, the provider must first void the original claim and resubmit a new claim on the correct claim form type using the CMS-1450.   
3. Submitting an incorrect claim ID number after a claim has been adjusted.  If you submit a corrected claim after a claim has been adjusted more than one time, you must file the most recently assigned claim ID number and not the original claim ID number.  

Coding guidelines when filing corrected claims: 

• Please do not attach a Doctor Claim Inquiry form to a paper submitted corrected claim as this delays processing. 
• Electronic submission HIPAA compliant 837 claims - for 837 institutional claims specify appropriate corrected claim indicator** in loop 2300, segment CLM05-3, for 837 professional claims specify appropriate corrected claim indicator** 2300, segment CLM05-3. ** 837 corrected claim indicators: 5 – Late charges only 7 – Replacement of a prior claim 8 – void or cancel claim 
• Electronic Blue e - institutional only - change bill type in form locator 4 on the CMS-1450 claims entry screen to reflect that it is a corrected claim and provide the original claim number in box 64. Electronic Blue e SM – professional only - correcting or voiding claims, set the correct claim flag to “Yes” on the Blue e SM CMS-1500 transaction and enter claim frequency type code (billing code) 7 for a replacement / correction, or 8 to void a prior claim, in the 2300 loop 
• 837 submissions: Loop 2300 REF 01 = F8 REF02 = original claim ID number for institutional and professional Loop 2300 CLM05-3 contains frequency code for institutional and professional. 

If you have any questions, please reach out to customer service 800-214-4844 or our eSolutions team at 888-333-8594.