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Submitting Corrected Claims

Providers may submit a corrected paper claim when an original claim has been denied or paid.  Reasons for submitting a corrected claim may vary but common examples include:

Providers may not submit a corrected claim when a claim has been rejected.  If a claim has been rejected, it means that the claim could not be accepted as submitted because it is missing or has invalid data elements that are required as outlined in the Claim Submission Guidance for Providers. In these cases, providers must resubmit a new claim that addresses the reasons for the original rejection.

It is critical that providers use the “Request for Claim Review Form” to submit a corrected claim.  Corrected claims submitted on a standard claims form cannot be recognized and will be denied as a duplicate claim.

If a provider disagrees with a processing decision of a claim, the provider can file a request for reconsideration. Use the “Request for Claim Review Form”. Examples of why a provider might request a reconsideration include:

The following table describes actions providers can take based on the disposition of a claim.

IF THEN REVIEW FORM REQUIRED?

A claim you submitted was rejected for missing or incorrect required data.  

Review the rejection reasons and submit the new claim that addresses the reason for the rejection. Rejected claims have not been entered into the PCG claiming system

No

A claim you submitted was paid, but you believe the payment amount is not correct.

Resubmit your claim with documentation supporting your position

Yes

A claim you submitted was denied and you believe the denial was incorrect. You’ll know this based on the Explanation of Benefits

Resubmit your claim with documentation supporting your position

Yes

 

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