Regence – Corrected Claims to Require Original Claim Number

In the Special Edition newsletter, notified that effective January 15, 2021, Regence will require corrected claims to include the original claim number. This applies to medical (professional and institutional) and dental professional corrected claims for all lines of business. A corrected claim is any claim that has a change to the original claim (e.g., changes or corrections to charges, procedure or diagnostic codes, dates of service, member name, etc.). Corrected claims should be submitted as soon as an error is identified.

Guidelines when submitting corrected claims: Electronic claims submission – In the 2300 Loop, the CLM segment (claim information), CLM05-3 (claim frequency type code) must indicate one of the following qualifier codes:

• “7” – REPLACEMENT (Replacement of prior claim)
• “8” – VOID (Void/Cancel of prior claim)

Effective January 15, 2021, the 2300 Loop, the REF01=F8 segment (claim information) must include the original claim number issued to the claim being corrected. The original claim number can be found on the:

• Electronic claims receipt confirmation reports or electronic remittance advisements
• 277CA Claim Acknowledgements
• Availity Portal, availity.com, Remittance Viewer Effective January 15, 2021, if a corrected claim is submitted without the original claim number, the claim will be rejected before it is processed.

Source: https://beonbrand.getbynder.com/m/3345550f54239b6c/original/The-Connection-December-2020.pdf