Does Medicare Accept Corrected Claims?

Medicare is a federal health insurance program providing coverage to millions of Americans. When healthcare services are provided to beneficiaries, providers submit claims to Medicare for reimbursement. Errors or omissions on these initial submissions can occur, and Medicare accepts corrected claims to rectify such inaccuracies. This process allows healthcare providers to ensure accurate billing and proper payment for rendered services.

Understanding Corrected Claims in Medicare

A corrected claim is a resubmission of an original claim that contained errors, aiming to adjust previously submitted information for proper adjudication. This differs from a new original claim, which is filed for a service not previously billed, or a voided claim, which completely cancels a prior submission. Corrected claims modify details on a claim that has already been processed or is in process, ensuring alignment with services rendered and Medicare’s billing requirements.

Common errors include incorrect patient demographic details, inaccurate procedure or diagnosis codes, wrong dates of service, or improper use of modifiers. For instance, billing for services not rendered or submitting claims with outdated codes can lead to denials or incorrect payments. These inaccuracies can result in claims being rejected, denied, or paid incorrectly.

Identifying these errors often relies on the Medicare Remittance Advice (RA) or Electronic Remittance Advice (ERA), which provide detailed explanations of claim processing. These documents include Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs). CARCs explain the primary reason for a claim adjustment, such as a denial or reduction in payment, while RARCs offer supplemental information or specific instructions for further action. Understanding these codes is important for providers to determine why a claim was not paid as expected and what specific corrections are required.

Preparing a Corrected Medicare Claim

Preparing a corrected Medicare claim begins with identifying the original submission. The original claim number, often referred to as the Internal Control Number (ICN) for Medicare Part B claims or the Document Control Number (DCN) for Part A, is important for linking the corrected claim to its initial submission. This unique identifier ensures Medicare systems can accurately associate the correction with the claim it is intended to modify.

Specific fields on the claim forms are designated for indicating a correction. For professional claims submitted on the CMS-1500 form, Box 22 is used to denote the type of submission. Here, a frequency code, such as “7” for a replacement of a prior claim or “8” for a void/cancel of a prior claim, must be entered. The original claim’s reference number is also placed in this box to establish the link to the initial submission.

Institutional claims, typically submitted on the UB-04 form (CMS-1450), utilize Form Locator 4 to indicate the frequency code for the corrected submission. Codes like “7” for replacement or “8” for voiding a claim are entered here. Additionally, condition codes like D0 (service dates), D2 (revenue/HCPCS codes), or D9 (general changes) may be required in the UB-04’s condition codes section to explain the correction. All original claim details should be re-entered on the corrected claim, with only the erroneous information adjusted.

Adhering to Medicare’s timely filing limits is important when submitting corrected claims. Generally, Medicare claims, including corrected ones, must be filed no later than 12 months (one calendar year) from the date services were furnished. If a claim is not filed within this timeframe, Medicare typically will not pay its share, with limited exceptions. For certain Medicare Advantage plans, corrected claims may be submitted within 365 days from the service date or within 60 days after the original claim’s payment, denial, or rejection, whichever is later.

Submitting and Tracking a Corrected Claim

Once a corrected claim has been prepared, including all necessary forms and codes, the next step involves its submission to Medicare. Electronic submission is the primary method for most providers, often facilitated through Electronic Data Interchange (EDI) systems. These systems allow providers to transmit claim files directly to a Medicare Administrative Contractor (MAC) or through a clearinghouse, which acts as an intermediary. Direct Data Entry (DDE) systems also offer a way for some providers, particularly for Part A claims, to manually enter, correct, or adjust claims directly into Medicare’s processing system.

For situations requiring paper submission, such as when a beneficiary files a claim directly, the completed CMS-1490S form, along with an itemized bill and any supporting documentation, is mailed to the appropriate Medicare administrative contractor. The specific mailing address varies by state and is typically found within the claim form instructions or on the MAC’s website.

After submission, confirmation of receipt is often provided, such as EDI acknowledgments for electronic submissions. Providers can then monitor the status of their corrected claims through various channels. Online portals offered by MACs, interactive voice response (IVR) systems, or subsequent Remittance Advice documents are common ways to track progress. While initial claims generally process within 30 days, corrected or adjusted claims may have a shorter processing time, sometimes as little as seven calendar days if they are considered “clean” claims without further errors. However, if issues persist, the reimbursement timeline can extend, necessitating further follow-up.