Reporting correct frequency code can prevent your claim from rejecting

With automated processing of replacement, late charge and void claims, you must report the correct bill frequency code for the type of claim you’re submitting. Failure to report the correct bill type and frequency code will result in a denial of your claim.

Here’s a look at the automated types of bills and the frequency codes that should be used:

Applies to reporting facility claims only:

• Late charge claim — Frequency code 5 should be used to report a late charge or charges on a facility claim. Frequency code 5 doesn’t apply to professional claims reporting. A facility late charge represents a service that wasn’t reported on your original claim. Only report the revenue code or codes and any required procedure codes that represent the late charges requested. A late charge claim won’t replace your original claim, but it will adjust your original claim to include payment consideration for the late charges reported.

Applies to reporting professional and facility claims:

• Replacement claim — Frequency code 7 is used when an original claim has been processed but needs to be replaced in its entirety.
• Void or cancellation of a prior claim — Frequency code 8 is used to request that we void your originally paid claim in its entirety.

The following reporting guidelines apply:

• The original claim has to be finalized before a late charge, replacement or void claim is reported.
• Report the 14-digit internal claim number from the original claim on your replacement or void claim. The internal claim number isn’t required on a late charge claim.
• All patient and provider demographics on your replacement, late charge or void claim must be reported exactly as you reported them on your original claim. For example, for a replacement claim (frequency code 7), if your request is to change the patient’s name or the national provider identifier on the claim, you should request a void of the original claim and report the correct patient or provider demographics as a new original claim.  
• If your original claim rejects because of a provider billing error, you can’t correct the claim by using frequency code 7. The rejection will instruct you to report a new original.
• Don’t attach a copy of a claim when submitting medical records to us. Instead, attach any supporting documentation to the Medical Records Routing Form. You can find this form by logging on to web-DENIS and following these steps:
• Click on BCBSM Provider Publications and Resources.
• Click on Newsletters & Resources.
• Click on Clinical Criteria & Resources.
• Click on Medical Records Routing Form under the Clinical criteria section.
• Professional replacement claims can be billed electronically and shouldn’t be reported on a paper 1500 claim form when the original claim was billed electronically. All facility claims must be reported electronically or by using our Internet Claims Tool.  
• A facility claim that was previously reported as an inpatient service can’t be changed to an outpatient claim using a replacement claim (frequency code 7). Request a void of the paid inpatient claim and bill the outpatient claim as a new original.
• Facility providers who choose to report late charges using frequency code 7 — replacing their original claim in its entirety — must be sure to include all the charges for services rendered to the patient and not just the late charges.

For additional information on the automation of facility and professional claims, see previously published Record articles from January 2016 and September 2015.

For more information on claims reporting, see the “Billing and Claims” chapter of the online provider manuals.

If you need information on the status of a claim you submitted, contact Provider Inquiry.