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Claim Adjustments/Correction Process - Reminders

Professional Claims Claim/Billing Frequency Type codes are used when billing to indicate whether a claim is a new/original claim or a replacement of a previously adjudicated (approved or denied) claim.

Claim corrections will only be allowed for 180 days from the original claim processing date for both professional and institutional claims unless it is one of the exceptions listed below:

  • Medicare
  • Coordination of Benefits
  • Workers Compensation
  • No-fault
  • Subrogation
  • Third-party Payers

Valid Frequency Type Claims

There are three valid Frequency Type claims that can be initiated:

1. Frequency Type 1 is an original claim. All new claims are submitted with this value.

2. Frequency Type 7 is a replacement of a prior claim. Frequency Type 7 is used to correct data reported incorrectly on the original claim. The original claim number assigned by BCBSND is required on this type of submission. Frequency Code 7 can be used for changes to diagnosis code, date of service or charges or to add services or remove a line of the claim.

* If the billing provider needs to be updated, the original claim with the incorrect billing provider will need to be voided as billed in error (Frequency Code 8) and a new claim 36 (Frequency Type 1) with the new billing provider will need to be submitted. Performing provider numbers can be corrected using Frequency Code 7.

3. Frequency Type 8 is a void/cancellation of a prior claim. Frequency Type 8 is used to completely void a claim that was reported in error. The original claim number assigned by BCBSND is required on this type of submission.

Electronic 837P Correction

The 837P allows you to submit a claim adjustment request electronically using a valid Frequency Type code. Corrected claims can be submitted through the Professional or Facility Claim direct claim entry function in Availity Provider Portal by selecting the Billing Frequency type 7 and providing the original claim number.

More information on both professional and institutional claims can be found in the provider manual