Get Connecticare Resubmission Request Form

Professional claims/CMS1500: Corrections should be billed using the claim number you are correcting and the proper resubmission codes, as outlined below: * -5 for late charges. * -7 for replacement of a prior claim. * -8 for voided or canceled claim.

If the claim was previously denied, but is within the 180 day filing limit, you may resubmit electronically.

Frequency code 8: • Must be used to fully void a claim. Must represent the entire claim—not just the line or item that you are retracting.

Frequency code (CLM05-03) The code 6 is labeled as corrected claim and the code 7 is labeled as replace submitted claim. It can be tough sometimes knowing what code a payer will want. If you need to file a corrected claim, it is best to first know what frequency code the payer accepts.

▪ 1 – Original claim submission. ▪ 7 – replacement. ▪ 8 – void.

Professional Claims If you are submitting a void/replacement paper CMS 1500 claim, please complete box 22. For replacement or corrected claim enter resubmission code 7 in the left side of item 22 and enter the original claim number of the claim you are replacing in the right side of item 22.

Frequency code 7 Replacement of Prior Claim: Corrects a previously submitted claim. Frequency code 8 Void/Cancel of Prior Claim: Indicates this bill is an exact duplicate of an incorrect bill previously submitted. This code will void the original submitted claims.

WHAT IS A CORRECTED CLAIM? A corrected claim is a replacement of a previously billed claim that requires a revision to coding, service dates, billed amounts or member information. CORRECTED CLAIM BILLING REQUIREMENTS.