Corrected claims: Submit a corrected claim when you need to revise information on a claim previously submitted and processed. The corrected claim will replace the previously submitted claim. Do not submit a corrected claim if an original claim was rejected or denied.

Claim voids: Submit a claim void when you need to cancel a claim already submitted and processed. A claim void must be identical to the original claim that it is intended to cancel.

How to submit a corrected claim or claim void

Follow the instructions below to file a corrected claim or void.

Electronic submissions

To submit a corrected claim or claim void electronically using forms 837I, 837P or 837D:

1. Find Loop 2300 (Claim Information)
   • In segment CLM05-3, enter correct frequency code value:
     • 7 – Replacement of prior claim
     • 8 – Void/cancel prior claim
   • In segment REF01, enter F8
   • In segment REF02, enter original 18-digit claim number
     
     
2. Complete all other claim fields as normal.

Paper submissions

Medical claims may use CMS Form 1500/HCFA or CMS Form 1450/UB-04 to submit a claim correction or claim void by paper. Dental claims use ADA Form J430 for a claim correction or a claim void by paper.

Submissions for using CMS Form 1500/HCFA

1. Find Box 22 – Resubmission Code. Enter the correct frequency code.
   • 7 – Replacement of prior claim
   • 8 – Void/cancel prior claim
   • Complete all other claim fields as normal.
     
     
2. In the original reference number space, enter the original claim ID. This is the original 18-digit claim ID found on the explanation of payment (EOP) produced upon initial processing.
   
   
3. Complete all other claim fields as normal.

NOTE:

• A claim submitted with an original reference number but without a corrected/voided frequency code will be processed as an original submission.
• A claim submitted with a frequency code 7 or 8 but without the original reference number will be rejected (for missing information).

Submissions for using CMS Form 1450/UB-04

1. Find Box 4 – Type of Bill (top, right-hand corner). Enter the correct resubmission code in the third digit of the bill type.
   
   
2. Find Box 64 – Document Control Number. Enter the original claim ID. This is the original 18-digit claim ID found on the explanation of payment (EOP) produced upon initial processing.

NOTE:

• A claim submitted without the third digit of the bill type reflecting a subsequent submission will be processed as an original submission.
• A claim submitted with a bill type signifying a subsequent submission but without the original claim ID will be rejected (for missing information).
• If you do not follow these instructions exactly, it may result in a duplicate claim denial.

Submissions for dental claims using ADA Form J430

1. In the top-right part of the form:
   • Write (legibly) the original claim ID/Transaction Control Number (TCN). This is the original 18-digit claim ID found on the explanation of payment (EOP) provided upon initial processing.
   • Write (legibly) the correct frequency code:
     • 7 – Replacement of prior claim
     • 8 – Void/cancel prior claim
       
       
2. Complete all other claim fields as normal.

NOTE:

• A dental claim submitted without a frequency code will be processed as an original claim submission.
• A dental claim submitted with a frequency code indicator of 7 or 8 but without an original claim ID/TCN will be rejected (for missing information)