Provider Alerts

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To:	Health Plan of San Joaquin (HPSJ) PCPs, Providers and Practice Billing Managers
From:	Provider Services Department
Subject:	ADVICE – Correcting CMS-1500 Claims Submissions Also, when NOT to submit a dispute
Business:	Medi-Cal, AIM (now known as Medi-Cal Access Program)

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This advice is offered to help providers with the proper ways to resubmit claims – for any of the reasons listed below.

Corrected claims submissions
When submitting a revised claim, HPSJ no longer asks providers to stamp or write the word “corrected” on the CMS-1500 paper or electronic form. But, claims do need to have the right billing code to help us identify when a claim is being submitted to correct a claim that we have processed.

Correcting electronic CMS-1500 claims –

• Enter this Claim Frequency Type (billing) code in the 2300 loop in the CLM*05 03:
  • Claim Frequency Type (billing) code 7, for a replacement/correction
• Enter the original claim number in the 2300 loop in the REF*F8*

Correcting paper CMS-1500 claims –

• Fill out box 22 (resubmission code) to include this code:
  • Code 7 (the “replace” billing code), to let us know this is a corrected or
    replacement claim
• For the Original Ref. No. – if available – enter the HPSJ “original” claim number.

NOTE: Corrected claims should be sent with ALL line items filled out for that claim, and they should never be filed with just the line items that need to be corrected.
If your claim denies as a duplicate, when NOT to submit a dispute –

•  If your claim denies as a duplicate and it was not sent with the right indicator for “corrected claim” submission, do not submit a dispute.
  April 20, 2016

Provider Alert: ADVICE – Corrected CMS-1500 Claims Submissions

• Resubmit the claim with the indicator for processing.
•  If a dispute is received, it will be returned to you to resubmit using the corrected
  claim steps listed above in this alert.

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Additional information about the CMS-1500 claim form is available by visiting the National Uniform Claim Committee website, at: www.nucc.org. Please share this information with your practice management software vendor, as well as your billing service or clearinghouse if appropriate. If you have any further questions, please contact our Provider Services Department at (209) 942-6340.