A corrected claim is a replacement of a previously submitted claim. Previously submitted claims that were completely rejected or denied should be sent as a new claim.
Should you need to submit a correction to a claim that has already been processed, Health Net Federal Services, LLC (HNFS) can accept corrected claims electronically, even if you submitted the original claim on paper. When you submit a corrected claim electronically, it's important to complete all required fields with the correct, required information.
If you have more than one claim to correct: Submit each corrected claim on a separate claim form. Do not put additional claim numbers in the notes section to combine corrections for multiple claims. Such claims will be returned.
Correcting electronically submitted claims
Providers who submit claims through electronic data interchange (EDI) should submit corrected claims via EDI in the HIPAA-compliant 837 format.
Do include the original claim number in the Original Reference No. field. The original claim number is in the remittance advice that the provider received for the original claim.
Refer to the applicable section below for tips specific to your billing type (professional or institutional).
- Electronic (Professional)
- Loop 2300, segment CLM05-3
- Reference Number: original claim number (no dashes or spaces)
- Payer Claim Control Number: loop 2300, segment REF02
and
- Resubmission/Claim Frequency Code field:
- '7' (replacement of prior claim)
or
- '8' (void/cancel prior claim)
- Electronic (Institutional)
- 'Patient-Bill-Type' should end with:
- '7' (replacement of prior claim)
or
- '8' (void/cancel prior clam)
Do not use loop 2300, segment AMT with an F5 qualifier (Patient amount paid), as 1) we do not require this information and 2) doing so will result in the claim processing as if the beneficiary paid out of pocket, causing reimbursement to go directly to the beneficiary instead of the provider.
Do not only list the line items being corrected. The corrected or replacement claim should list all line items included in the original claim. Only listing the line items being corrected may result in recoupment of services that were paid on the original claim.
Correcting paper-submitted claims
Providers who submit paper claims can use XPressClaim® to submit corrections.
- For professional claims, select "7-Replacement of Prior Claim" as the claim type and enter the original claim number (no dashes or spaces) in the Prior Claim Number field.
- For institutional claims, select "7-Replacement of Prior Claim" as the claim frequency and enter the original claim number in the Payer Claim Control Number field.
Corrected claims with attachments
Corrected claims with supporting documentation, such as an Explanation of Benefits (EOB) or Certificate of Medical Necessity (CMN), can be sent electronically, even if the original submission was via paper.
To expedite claims processing, use the “Upload Documents" feature on our secure portal. From the drop-down menu, choose "Corrected Claim" as the document type.
Claims with supporting documentation include those:
- For patients who have other health insurance (OHI) and you need to include the OHI EOB
- With medical documentation
- With a CMN
- With possible third party liability (TPL) and you need to include the patient-signed DD Form 2527 TPL form
Learn more on our XPressClaim page.
XPressClaim® is registered trademark of PGBA, LLC.
