Corrected Claims

A corrected claim is any claim that has a change to the original claim (e.g., changes or corrections to charges, procedure or diagnostic codes, dates of service, member name, etc.) Corrected claims may be submitted immediately.

Electronic claims
Corrections can be sent to us in an electronic format.

• Indicate in the 2300 loop the CLM 05-3 if the claim is an original=1, replacement =7, or void or cancel=8.
• Include "corrected claim" in the narrative record (NSC Record HAO) of the first service detail line.

Paper claims
To ensure the corrected claim is routed to the appropriate area for reprocessing, attach a Corrected Claim Cover Sheet (PDF) to your corrected paper claim. Include the following:

• Complete all applicable fields on the Corrected Claim Cover Sheet.
• Attach a copy of the original claim with the corrections added to the copy
• Indicate the reason(s) for the correction (corrected charges, diagnosis, patient information, etc.)
• Include the claim number that needs to be corrected. The claim number is located on your payment voucher.

Paper claims resubmitted with changes should be marked "corrected claim" in the upper right hand corner or in Field 24 of your CMS-1500 or ADA dental claim form.

For UB-04 corrected claims, use the Type of Bill code 7 Replacement of prior claim as the third digit and indicate the changes in the remarks field.

Send corrected paper claims to:

Asuris Northwest Health
P.O. Box 30271
Salt Lake City UT 84130-0271

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