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DPAP 202

Reprocessed and Corrected Claims


Provider Administrative Policy

Section
Claims Submission
Policy Date
January 2012
Status/Date
Revised/December 2012
Provider Type(s)
All Providers  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Blue Cross of Idaho works diligently on behalf of our members to develop contracting relationships with Idaho dental providers and Blue Cross Blue Shield dental affiliates (national Dental Grid).

 


Policy

Reprocessed and Corrected Claims

If you have a question about payment on a claim for date of service on or after January 1, 2012:

  1. Visit the secure provider portal on the Blue Cross of Idaho website, bcidaho.com, select Dental Eligibility and Claims and review the member benefits document.
  2. To determine how we processed a claim, select either the BCI Member Search or the Claims link located under Dental Eligibility and Claims.

If you have concerns with how we processed a claim after checking the website, please contact Customer Service to have the claim reviewed for benefits. You do not need to resubmit the claim unless directed by Customer Service or the remittance advice message on the claim requests a corrected claim.

Procedure for Submitting Corrected Claims
You can submit corrected bills electronically or hard copy.

  • Electronic format: ANSI-837D - (Dental)

You must resubmit the entire claim with all charges. In addition, both items listed below must be completed for Blue Cross of Idaho to consider an ANSI-837 dental claim a corrected claim. If these items are not completed, we will deny the claim as a duplicate.

In the 2300 loop, CLM segment (claim information), CLM05-3 (claim frequency type code) must indicate the following qualifier code:

  • "7"- REPLACEMENT (Replacement of Prior Claim)

NOTE:  In the NTE segment, add comment "corrected bill" and either the original claim number or a notation of what has been corrected.

Hardcopy format:
Resubmit the entire American Dental Association (ADA) claim form with your corrections and "corrected claim" highlighted in yellow and noted in the upper right corner. Blue Cross of Idaho will adjudicate the claim accordingly. Do not attach a cover letter - it will delay your reprocess request.

Timely Filing Reminder (All Providers)
When Blue Cross of Idaho is the primary health insurance, per your provider contract, submit claims within 12 months of delivery of service.

In some cases, Blue Cross of Idaho grants an exception to the 12 month requirement if questions or disputes cause greater delay by involving third-party liability, subrogation and coordination of benefits among or between insurers or third-party payors or other situations that the provider has no control over.

We must receive corrected claims or request for payment adjustments within 12 months following the original date of payment.

If you disagree with a payment determination, you have 60-days from the date of the remit to inquire about the claim and submit a request for reconsideration.


Policy History

Date Action Reason
December 2012 Revised Added American Dental Association and removed 2006 for ADA clam form.
January 2012 Revised Added electronic claim corrections