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  • Molina Corrected Claim Form

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Corrected Claim Form Standard Cover Sheet Participating providers have 90 days from the date of the original remittance advice to submit corrected claims. Nonparticipating providers have 365 days.

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Complete box 22 (Resubmission Code) to include a 7 (the "Replace" billing code) to notify us of a corrected or replacement claim, or insert an 8 (the Void billing code) to let us know you are voiding a previously submitted claim. Enter the Blue Cross NC 'original' claim number as the Original Ref.

You can send a corrected claim by following the below steps to all the insurances except Medicare (Medicare does not accept corrected claims electronically). To submit a corrected claim to Medicare make the correction and resubmit as a regular claim (Claim Type is Default) and Medicare will process it.

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.

Navigate to Filing > CMS-1500. Locate the Print & Mail claim you need to send a Corrected Claim for. Click the. ... Under Step 1, select the claims that you want to create the Corrected Claim for. ... Under Step 2, indicate if you would like do one of the following: ... Select Create.

Please contact the Provider Call Center for claims status information at (855) 322-4077, Monday Friday 8:00 a.m. 5:00 p.m. EST; you may inquire about three (3) claims per call. billed for the service(s). or submit an e-mail to EDI.Claims@MolinaHealthcare.com.

A corrected claim is used to update a previously processed claim with new or additional information. A corrected claim is member and claim specific and should only be submitted if the original claim information was incomplete or inaccurate. A corrected claim does not constitute an appeal.

Complete box 22 (Resubmission Code) to include a 7 (the "Replace" billing code) to notify us of a corrected or replacement claim, or insert an 8 (the Void billing code) to let us know you are voiding a previously submitted claim. Enter the Blue Cross NC 'original' claim number as the Original Ref.

All claims must be filed with your Medicare contractor no later than one calendar year (12 months) from the date of service or Medicare will deny them. If a claim requires correction, a corrected claim must be filed 12 months from the date of service.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232