Electronic Submission of Professional and Institutional Corrected Claims

Tuesday, July 5, 2022

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 accurate, required information. 

Tips for electronic submission of corrected claims

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.

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). 

Professional billing

• 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)

Institutional billing

• ‘Patient-Bill-Type’ should end with: 
  • ‘7’ (replacement of prior claim) 
    or
  • ‘8’ (void/cancel prior claim)

For more information, visit our Submitting Corrected Claims page.