Reminder: New Requirement for 837P Claim Correction Requests Coming 1/1/18 

Requests No Longer Accepted Via Telephone Inquiry or NaviNet® Investigation

As noted Oct. 25, 2017, on the NaviNet® Plan Central page, Highmark will no longer accept requests for claim corrections via telephone or NaviNet investigations, effective Jan. 1, 2018. Providers instead must submit claim corrections electronically.

Following are the three valid Frequency Types for claim corrections:

  • Frequency Type 1 is an original claim. 
  • Frequency Type 7 is a replacement of a prior claim.
    • Frequency Type 7 is used when a claim has been processed for payment but you identify an error on the original claim that requires correction. The information you enter on the replacement claim represents a complete or partial replacement of the previously submitted original claim.
  • Frequency Type 8 is a void or cancellation of a prior claim.
    • Frequency Type 8 is used only when elimination of a previously submitted claim is required. This code will cause the claim to be completely canceled from Highmark’s claims processing systems.

Please note: The original Highmark assigned claim number is required on all Frequency Type adjustment claims (Types 7 and 8).

In the HIPAA 837P Claim Transaction, the Frequency Type Code is reported in the 2300 Loop, CLM05-3 element. The original claim number is reported in Loop 2300, ORIGINAL REFERENCE NUMBER (ICD/DCN) REF segment.

Adjusted claims can be submitted within the NaviNet® claim entry screen by selecting the appropriate frequency type code and providing the original claim number.

Additional details about electronic claims adjustment requests can be found on Page 21, Chapter 5, Unit 2, of the Highmark Blue Shield Office Manual, which is available on our Provider Resource Center under Education/Manuals.

Paper Claims

All providers are encouraged to file electronic claims. However, effective Jan. 1, 2018, you must submit a paper replacement claim if your original claim was submitted on paper. In Box 22, enter the correct Frequency code under Resubmission code, and Original Claim Number under Original Ref. No. to indicate you’re submitting a replacement claim.

 

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