August 2018

Electronic Replacement/Corrected Claim Submissions

The Blue Cross and Blue Shield of Texas (BCBSTX) claims system recognizes electronic claim submission types by the frequency code submitted. The ANSI X12 837 claim format allows you to submit changes to claims that were not included on the original adjudication.

Claim Frequency Codes
The 837 Implementation Guides refer to the National Uniform Billing Data Element Specifications Loop 2300 CLM05-3 for explanation and usage. In the 837 formats, they are called “Claim Frequency Codes.” Using the appropriate code, you can indicate that the claim is an adjustment of a previously submitted finalized claim.

Use the frequency codes below for claims that were previously adjudicated.

Claim Frequency Codes
Code	Description	Filing Guidelines	Action
5 Late Charges (Institutional Providers Only)	Use to submit additional charges for the same date(s) of service as a previous claim.	File electronically, as usual. Include only the additional late charges that were not included on the original claim.	BCBSTX will add the late charges to the previously processed claim.
7 Replacement of Prior Claim	Use when replacing the entire claim (all but identity information).	File electronically, as usual. File the claim in its entirety, including all services for which you are requesting reconsideration.	BCBSTX will adjust the original claim. The corrections submitted represent a complete replacement of the previously processed claim.
8 Void/Cancel of Prior Claim	Use to eliminate a previously submitted claim for a specific provider, patient, insured and "statement covers period."	File electronically, as usual. Include all charges that were on the original claim.	BCBSTX will void the original claim from records based on this request.

Submitting Electronic Replacement Claims
When submitting claims noted with claim frequency code 7 or 8, the original BCBSTX claim number, also referred to as the Document Control Number (DCN), must be submitted in Loop 2300 REF02 – Payer Claim Control Number with qualifier F8 in REF01. The DCN can be obtained from the 835 Electronic Remittance Advice (ERA) or Electronic Payment Summary (EPS)*. Without the original BCBSTX DCN, adjustment requests will generate a compliance error and the claim will be rejected. BCBSTX only accepts claim frequency code 7 to replace a prior claim or code 8 to void a prior claim.

Specific information and examples for professional and institutional providers are included below.

Professional Providers
Claim corrections submitted without the appropriate frequency code will deny and the original BCBSTX claim number will not be adjusted. For additional information on submitting electronic replacement claims, please refer to the table and examples below.

Code	Action
7 Replacement of Prior Claim	BCBSTX will adjust the original claim. The corrections submitted represent a complete replacement of the previously processed claim.
8 Void/Cancel of Prior Claim	BCBSTX will void the original claim from records based on this request.

An example is provided below of the ANSI 837 CLM segment containing the claim frequency code 7, along with the required REF segment and Qualifier in Loop ID 2300 - Claim Information.

claim_frequency

Institutional Providers
Claim corrections submitted without the appropriate frequency code will deny as a duplicate and the original BCBSTX claim number will not be adjusted. For additional information on submitting electronic replacement claims, please refer to the table and examples below.

Code	Action
5 Late Charges	BCBSTX will add the late charges to the original processed claim.
7 Replacement of Prior Claim	BCBSTX will adjust the original claim. The corrections submitted represent a complete replacement of the previously processed claim. This code is not intended to be used in lieu of late charges.
8 Void/Cancel of Prior Claim	BCBSTX will void the original claim from records based on this request.

When submitting corrected institutional claims, take note of CLM05-2, the Facility Code Qualifier. In this instance, the CLM05-2 field would require a value of “A” indicating an institutional claim – along with the appropriate frequency code 7 as illustrated in the example below.

claim_frequency

Note: If a charge was left off the original claim, submit the additional charge with all the previous charges as a replacement claim using frequency code 7. All charges for the same date of service should be filed on a single claim.

Frequency code 5, Late Charge(s) applies strictly to institutional claims.

*EPS files are not available for Medicaid STAR, STAR Kids, CHIP, Blue Cross Medicare Advantage HMO^SM or Blue Cross Medicare Advantage PPO^SM claims.