Health Choice Utah prefers to receive corrected claims via EDI transaction. To request a corrected claim, submit the following information in Loop 2300 of an 837I (Institutional) or 837P (Professional) electronic claim form.

SUBMITTING CORRECTED CLAIMS VIA EDI

1. Indicate the Claim Frequency Type Code

   In segment CLM05-3, enter the appropriate Claim Frequency Type Code (your software may display this as a dropdown):

   • 7 – Replacement of prior claim
   • 8 – Void/Cancel prior claim

2. Include the Original Claim Number

   Enter the original claim number in the REF*F8 (Payer Claim Control Number) field.

3. If Submitting a Primary Payer's EOP

   If you are submitting a primary payer's EOP with the corrected claim, you must ensure the claim balances and includes the primary payment date (DTP*573).

4. Reporting All Lines for Reprocessing

   All service lines associated with the claim must be reported to ensure the entire claim is reprocessed.

Refer to your 5010 Implementation Guide for additional EDI submission details.

SUBMITTING CORRECTED CLAIMS ON PAPER FORMS

CMS-1500 (02/12) – Professional Claims

If you must submit a corrected claim on paper:

Box 22 – Resubmission Code

Enter the appropriate code:

• 7 – Correction to prior claim
• 8 – Void of a professional claim

Enter the payer's original claim number under "Original Ref. No." in Box 22.

If you are resubmitting to add an EOP, ensure the primary EOP is attached.

UB-04 FACILITY CLAIMS

Box 4 – Type of Bill

Enter the Claim Frequency Type Code as the 4th digit:

• 7 – Correction to prior claim
  • Example: 0137 = correction to a Hospital Outpatient claim
• 8 – Void of a facility claim

Box 64 – Document Control Number

Enter the payer's original claim number in Box 64.