You must correct claims that were filed with incorrect information, even if the claim has been paid.
The most common reasons we reject claims are:
- The NPI is incorrect, is not listed on the claim or does not match the recorded tax identification number registered in our system
- Invalid member ID number
- The original claim number is not included on a void, replacement or corrected claim
- The EDI void and replacement requests do not include the required information, such as the original claim number
Missing NPI Number: If we reject a claim for a missing NPI number, you must send it as a new claim with updated information.
Additional documentation requested: If we requested additional information, simply resubmit the claim with the additional documentation. Do not submit it as a corrected claim.
The process for correcting an electronic claim depends on what needs to be corrected:
- For provider name, NPI number, member name, or member ID number changes, you must first process a void claim, and then file a new claim
- To correct billing errors, such as the procedure code or dates of services, file a replacement claim
Replacement and void corrections must include the original claim number in a specific position in the 837: Loop 2300, Segment REF – Payer Claim Control Number, with F8 in position 01 (Reference Identification Qualifier) and the original claim number in position 2.
For more information on electronic replacement and void requests, please see the EDI Claims Companion guide for 5010, page 17, or contact your Provider Relations representative or our EDI department.
To submit a corrected claim:
- Print out a new claim with corrected information
- Write “Corrected Claim” and the original claim number on the top of the claim
- Circle all corrected claim information
- Include the plan claim number, which can be found on the remittance advice
- Denote the item(s) needing correction (please do not hand-write in a new diagnosis, procedure code, modifier, etc.)
Submit the claim in the time-frame specified by the terms of your contract to:
Well Sense Health Plan
P.O. Box 55049
Boston, MA 02205