Automated system designed to improve processing of replacement and void claims for professional providers

Blue Cross Blue Shield of Michigan implemented an automated process, starting Feb. 19, 2016, to improve the processing of replacement and void professional claims, including Federal Employee Program^® and BlueCard^® claims.

Following are the claim frequency codes for these types of claims and a description of each:

Claim Frequency Code 7 – A replacement claim replaces the entire original claim. The original claim that was previously processed is replaced with the frequency code 7 claim you report. Replacement claims should be reported when adding or deleting lines on the claim, changing quantities or changes on the claim.

Claim Frequency Code 8 – Void/cancel reflects the elimination in its entirety of a previously submitted bill for a specific provider, patient, subscriber and payer for a statement coverage period. The void/cancel claim must be billed exactly as the original claim you’re asking us to void.

Void/cancel claims are reported when you ask that we cancel the claim that we previously processed. If you report a void/cancel claim because you reported the incorrect provider or patient information on the original claim, the corrected claim must be reported as a new original claim.

Professional providers should follow these steps when submitting an electronic replacement or void/cancel 837 claims or a paper CMS-1500 claim form:

1. Include the appropriate claim frequency code in the 837 file to indicate that the claim is an adjustment of a previously approved or denied claim. Enter the code in the CLM05-3 segment of loop 2300. For paper claims, these values should be reported in field 22 on the CMS-1500 form.
2. In the REF*F8 segment of loop 2300, include the 14- or 17- character internal claim number that was returned on the original claim. For paper claims, these values should be reported in field 22 on the CMS-1500 form.
3. Report the same provider NPI and billing information that was reported on the original claim for both replacement and void/cancel claims.
4. Report the same contract number of the original, finalized claim.

Example: A claim was previously submitted with procedure codes *99214, *70052 and *99213, but procedure codes *70052 and *99213 were submitted in error. An electronic replacement claim should be submitted with frequency code 7 and procedure code *99214. This claim will then be adjusted to remove *70052 and *99213 so that the claim will be processed with procedure code *99214 alone.

Note:  Don’t report a replacement or void claim until your original claim has been finalized.

Claims reporting contact information

• If you have questions on the electronic reporting of an 837 health care claim, contact the Electronic Data Interchange help desk at 1-800-542-0945.
• For assistance with the electronic reporting of claims for your office, contact your software vendor or clearinghouse.
• If you have questions about a claim you have billed, call Provider Inquiry.
• If you have any additional concerns that can’t be addressed by Provider Inquiry, contact your provider consultant.