Corrected Claims
Tufts Health Plan accepts both electronic and paper corrected claims, in accordance with guidelines of the National Uniform Claim Committee (NUCC), the Medicare Managed Care Manual, and HIPAA EDI standards for Tufts Medicare Preferred HMO claims.
Electronic Submissions
To submit a corrected facility or professional claim electronically:
** Enter the frequency code (third digit of the bill type for institutional claims; separate code for professional claims) in Loop 2300, CLM05-3 as either “7” (corrected claim), “5” (late charges), or “8” (void or cancel a prior claim).
** Enter the last 8 digits of the original claim number in Loop 2300, REF segment with an F8 qualifier. For example, for claim #000123456789, enter REF*F8*23456789.
Note: Provider payment disputes that require additional documentation must be submitted on paper.
Paper Submissions
Disputes (not corrected claims) must include a completed Provider Request for Claim Review Form. Both corrected claims and disputes, however, should be mailed to the address on the form.
For a corrected facility claim:
** On the UB-04 (CMS-1450) form, enter either “7” (corrected claim), “5” (late charges), or “8” (void or cancel a prior claim) as the third digit in Box 4 (Type of Bill), and enter the original claim number in Box 64 (Document Control Number).
For a corrected professional claim:
** In Box 22 (Medicaid Resubmission Code) on the CMS-1500 form, enter the frequency code “7” under “Code” and the original claim number in the same box under “Original Ref No.”