User Guide — Corrected Medicare Claims

 

No Follow-Up and No Posting practices are responsible for submitting their own corrected claims. To submit a corrected claim to Medicare, the No Follow-Up and No Posting practice can follow one of these two methods:

 

Method 1

If the Medicare carrier has a phone number referred to as a "re-opening line" and you have a minor administrative change to the claim, you can call the re-opening line at the payer and make the corrections right over the phone. Examples of minor administrative changes include adding a modifier, changing the number of units, adding a CPT code, etc.

 

Method 2

For anything other than minor administrative changes, the claim must be submitted as a redetermination request. You need the proper Medicare Redetermination Form, the corrected claim form that you print at the practice, the original EOB, and any supporting documentation.

 

The practice cannot use "force drop to paper: yes-athena" with the reason of "Corrected claim for insurance rebill" because if they do, rule 2725 will fire stating "Medicare paper submissions are disallowed. Per HIPAA, initial Medicare claims should be submitted electronically as of October 16, 2003. Please choose another means of submitting this claim."

 

The practice cannot kick to CBOHOLD with the kick code CORRECT because these clients are their own CBO.

 

The practice can send a corrected claim on paper if it is sent as a redetermination request with all the proper forms and documents, but calling is the easiest and fastest way.