Effective January 1, 2018, Highmark will no longer accept requests for claim corrections via telephone or NaviNet® investigation. Providers instead must submit corrected (replacement) claims electronically.
Because electronic replacement claims normally process in the same time frame as an original claim, your adjustments will likely process faster than those changes requested via phone or NaviNet investigation.
Highmark’s systems recognize claim submission types based on the claim frequency code submitted on professional (837P) electronic claims.
There are three valid Frequency Type claims:
The original claim number assigned by Highmark is required for all Frequency Type adjustment claims. Providers must work with their practice management system vendor to ensure the Highmark-assigned claim number is reported in the 837P, Loop 2300, REF – Payer Claim Control Number Segment.
This requirement also applies to claims already adjusted that now require a second (or subsequent) adjustment.
Please note: Electronic corrected claims will replace the previously processed claims. When submitting a correction, send the claim with all changes exactly as the claim should be processed.
| When to use | Highmark action | Examples of corrected claims that can be submitted |
Use Frequency Type 7 when Highmark has processed a specific claim for payment and you have identified an error on the original claim. Information present on the corrected claim represents a complete or partial replacement of the previously submitted claim. |
The initial claim is identified based on the original claim number reported. The replacement claim data is used to review, reprocess, and adjust the original claim as appropriate. The result could be an additional payment, no change in payment, or taking back an overpayment. The Frequency Type 7 or replacement claim will be reflected as a denied claim on the EOB and/or electronic remittance. Denials on the EOB will report Highmark proprietary code ― E0775: The adjustment request received from the provider has been processed. The original claim has been adjusted based on the information received. The 835 will report Claim Adjustment Group and Reason Code ― CO129: Prior processing information appears incorrect. Remark Code N770 will also be reported. (N770 – The adjustment request received from the provider has been processed. Your original claim has been adjusted based on the information received.) |
When a change is made to a service, such as:
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Additional information about how to submit electronic corrected claims begins on Page 21, Chapter 5, Unit 2, of the Highmark Blue Shield Office Manual, which is available on our Provider Resource Center.
All providers are encouraged to file electronic claims.
However, effective January 1, 2018, you must submit a paper replacement claim if your original claim was submitted on paper.
In Box 22, enter the Frequency code under Resubmission code and Original Claim Number under Original Ref. No. to indicate you’re submitting a replacement claim.
