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Reprocessed and Corrected Claims


Provider Administrative Policy

Section
Claims Submission
Policy Date
February 2008
Status/Date
Revised/January 2013
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.

Policy

Reprocessed and Corrected Claims

If you have a question about payment on a claim:

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

If you have concerns with how a claim was processed after checking the website, please contact Customer Service via email to have the claim reviewed for benefits at providerinquiries@bcidaho.com. You do not need to resubmit the claim unless advised by Customer Service or the remittance advice message requests a corrected claim.

Procedure for Submitting Corrected Claims - CMS 1500 Form (Professional Provider)
You can submit corrected bills electronically or hard copy.

  • Electronic format: ANSI-837P - (Professional)

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 professional claim a corrected claim. If these items are not completed, we will deny the claim as a duplicate.

In the 2300 loop, the 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.

Hard copy format:

Resubmit the entire claim with your corrections and "corrected claim" highlighted in yellow and noted in the upper right corner. Blue Cross will adjudicate the claim accordingly. Attaching a cover letter will result in a delay of your reprocessed request.

Hospital Claims Submitted on UB-04 form (Facility Provider)
Please include all hospital charges related to a single patient visit on the initial claim. Resubmit the entire UB-04 form with corrections and the appropriate bill type indicating "corrected claim."

Timely Filing Reminder (All Providers)
When Blue Cross is the primary health insurance, per your provider contract, submit claims within 180 days of delivery of service.

In some cases Blue Cross of Idaho grants an exception to the 180-day 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.

Blue Cross of Idaho may process a claim filed after 180 days but will deny all claims older than 12 months.

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 remit to inquire about the claim and submit a request for reconsideration.


Policy History

Date Action Reason
January 2013 Revised Updated new process to contact CS via email
June 2012 Revised Language changed from 90 days to 180 days
November 2010 Revised Electronic submission information added
October 2009 Revised #2 revised
March 2009 Revised Added eligibility and claims language
November 2008 Revised Language clarification
August 2008 Revised Online language revised
May 2008 Revised Online language revised

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