Claims Resubmission (or Refiling)
When a claim is refiled for any reason, all services should be placed on the claim. For example, it is inappropriate to refile a claim with only one procedure when more than one procedure was placed on the initial claim. Splitting the claim may cause adjustments to be performed.
Adjustment and Void Claim Submissions
Adjustment and Void claims can be submitted on any claim that has completed the processing cycle and appears on your BCBS Remittance Advice. The claim number assigned on the remittance will be needed to submit an adjustment or void claim.
Void Claim- The submission of a void claim is requesting that the entire claim be removed and any payments or rejections be retracted from the member and provider’s records.
Adjustment Claim- The submission of an adjustment claim requests that a previously processed claim be changed (information or charges added to, taken away or changed).
Electronic (837I & 837P) Adjustment and Void Claims
Adjustments and Void claims can be submitted for all changes except for changes to the member ID or pay-to-provider number. If these fields require change, you must submit the claim on paper, clearly indicating the old information and new information (pay-provider number and/or member ID). To submit these claims, you first obtain the claim number found on the Remittance Advice. This claim number will be used in the ICN (internal control number) field.
Ensure the accurate electronic (837I or 837P) submission by following the instructions below:
Adjustment Claim
• Enter the frequency code “7” in Loop 2300 Segment CLM05-03.
• Enter the 10-character ICN of the original claim (assigned on the processed claim) in Loop 2300 in an REF segment and use F8 as the qualifier.
Note: The Adjusted claim should include all charges (not just the difference between the original claim and the adjustment).
Void the Claim
• Use frequency code “8” in Loop 2300 Segment CLM05-03.
• Use the 10-character ICN of the original claim (assigned on the processed claim) in Loop 2300 in an REF segment and use F8 as the qualifier.
ILinkBLUE Facility UB04 Adjustment and Void Claims
• Field 4 Institutional Claim type of bill 3rd position (frequency) is required: 7 - Adjustment
8 - Void
• Field 64 Internal Control Number (ICN Number) – The ICN Number is the claim number from the BCBSLA Remittance Advice (Provider Payment Register).
ILinkBLUE Professional 1500 Adjustment and Void Claims
• Field 19a Professional Claim Adjustment/Void Indicator is required:
A - Adjust original claim
V - Void original claim
• Field 19b Internal Control Number (ICN Number) – The ICN Number is the claim number from the BCBSLA Remittance Advice (Provider Payment Register).
When a claim is refiled for any reason, all services should be placed on the claim. For example, it is inappropriate to refile a claim with only one procedure when more than one procedure was placed on the initial claim. Splitting the claim may cause adjustments to be performed.
Adjustment and Void Claim Submissions
Adjustment and Void claims can be submitted on any claim that has completed the processing cycle and appears on your BCBS Remittance Advice. The claim number assigned on the remittance will be needed to submit an adjustment or void claim.
Void Claim- The submission of a void claim is requesting that the entire claim be removed and any payments or rejections be retracted from the member and provider’s records.
Adjustment Claim- The submission of an adjustment claim requests that a previously processed claim be changed (information or charges added to, taken away or changed).
Electronic (837I & 837P) Adjustment and Void Claims
Adjustments and Void claims can be submitted for all changes except for changes to the member ID or pay-to-provider number. If these fields require change, you must submit the claim on paper, clearly indicating the old information and new information (pay-provider number and/or member ID). To submit these claims, you first obtain the claim number found on the Remittance Advice. This claim number will be used in the ICN (internal control number) field.
Ensure the accurate electronic (837I or 837P) submission by following the instructions below:
Adjustment Claim
• Enter the frequency code “7” in Loop 2300 Segment CLM05-03.
• Enter the 10-character ICN of the original claim (assigned on the processed claim) in Loop 2300 in an REF segment and use F8 as the qualifier.
Note: The Adjusted claim should include all charges (not just the difference between the original claim and the adjustment).
Void the Claim
• Use frequency code “8” in Loop 2300 Segment CLM05-03.
• Use the 10-character ICN of the original claim (assigned on the processed claim) in Loop 2300 in an REF segment and use F8 as the qualifier.
ILinkBLUE Facility UB04 Adjustment and Void Claims
• Field 4 Institutional Claim type of bill 3rd position (frequency) is required: 7 - Adjustment
8 - Void
• Field 64 Internal Control Number (ICN Number) – The ICN Number is the claim number from the BCBSLA Remittance Advice (Provider Payment Register).
ILinkBLUE Professional 1500 Adjustment and Void Claims
• Field 19a Professional Claim Adjustment/Void Indicator is required:
A - Adjust original claim
V - Void original claim
• Field 19b Internal Control Number (ICN Number) – The ICN Number is the claim number from the BCBSLA Remittance Advice (Provider Payment Register).
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