Corrected Claims Submissions
Clean claim resubmissions must be received no later than 12 months from the date of services or 12 months after the date of eligibility posting, whichever is later.
A corrected claim is one that may have been denied for:
- Needing additional information
- Incorrect date of service
- Timely filing
- Incorrect procedure code/modifier
- Age/gender, age/procedure
- Number of units
- Bill type
To resubmit a corrected EDI claim, the Claim Frequency code (3rd character in the bill type) in the 2300 loop CLM05-3 segment should be populated with a '7' to indicate replacement of previous claim. The original Health Net Access generated claim ID, if known, should be sent in the 2300 CLM loop with a REF segment with an F8 qualifier.
To resubmit on paper, corrected claims must be appropriately marked as such. For a UB04, the 3rd digit of the bill type in Box 4 should indicate a '7' as a replacement of previous claim. The Health Net Access generated claim ID in Box 65 labeled Payer Claim ID. For CMS1500 submission, the claim resubmission code in Box 22a should contain a '7' for replacement of previous of claim and the original Health Net Access generated claim ID should be sent in Box 22b labeled the Original Ref number.
Resubmitted paper claims must be sent to:
Health Net Access, Inc.
PO BOX 14095
Lexington, KY 40512