Corrected Claim Process Update: Changes Will Go Directly on Replacement Claim
Starting Aug. 23, 2024, providers will make corrections directly on the Replacement Claim — rather than the Adjustment Claim — when submitting a Frequency Type 7 claim or Type of Bill that ends in 7. This change only applies to the following lines of business: Commercial and Medicare Advantage.

NOTE: This change does not apply to Medicaid products, including Highmark Wholecare, Highmark Health Options Delaware, or Highmark Health Options West Virginia.

In Health Insurance Portability and Accountability Act (HIPAA) 837I and 837P claim transactions, the Frequency Type 7 claim is reported in the 2300 Loop, CLM05-3 element. The original claim number is reported in Loop 2300, as “Orig Clm No.”

For transactions via Availity®, corrected claims can be submitted within the claim entry screen by selecting Frequency Type 7 and providing the original claim number.

Current Process

Here’s how the current correction or adjustment claims process works:

  1. Provider submits a claim for services.
  2. Identifies an error on the original claim.
  3. Provider then submits a Frequency Type 7 claim or Type of Bill that ends in 7 (Replacement Claim) to correct the original claim.
  4. The Adjustment Claim appears in the reference field of the Replacement Claim.
  5. The Claims Processing System makes the changes on the original claim.

What Is Changing

The Replacement Claim will now process as the new claim and any future reference to the changes would be made on the Replacement Claim. The Adjustment Claim will serve as a notification to providers that a correction has been made; the Replacement Claim will document the actual correction(s).