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Wps corrected claim form

Wps corrected claim form 2025

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The document is a WPS Corrected Claim Form intended for making corrections to paid or partially paid services. It outlines the necessary information required from the provider and member, including details about the original and new claim amounts, units, dates, and authorization codes. The form must be completed accurately and submitted with the appropriate remittance advice; otherwise, it will be returned. It also provides instructions for claims denied in full and specifies that updated authorizations are required prior to submission for certain denial reasons.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Is resubmission code 6 or 7?

When resubmitting a claim, enter the appropriate frequency code: 6 - Corrected Claim. 7 - Replacement of Prior Claim.

How do I submit a corrected claim on ub04?

This could be due to an input error, incorrect data or data that does not match what the payer has on file. Denied claims have been processed and adjudicated but are denied and deemed unpayable. The denial could be for a number of reasons.

How do I submit a corrected CMS 1500 claim form?

If you are submitting a void/replacement paper CMS 1500 claim, please complete box 22. For replacement or corrected claim enter resubmission code 7 in the left side of item 22 and enter the original claim number of the claim you are replacing in the right side of item 22.

What is the submission code for a corrected claim?

Corrected Claim Submission: EDI Claims Corrections can be sent in an electronic format. On the CMS-1500 Form, use Corrected Claim Indicator (Medicaid Resubmission Code). Enter the frequency code 7 in the Code field and the original claim number in the Original Ref No. field.

What is the tob for a corrected claim?

Go to the Type of Bill (TOB) field (FL04) and replace the third digit to 7. Proceed to enter the Document Control Number (DCN) or Claim Number field (FL64) for the corrected claim. Click the button at the top of the screen. This will resubmit it as a corrected claim.

How to submit a corrected claim on UB04?

Use red drop on UB-04 paper forms only. Replacement/corrected claims require a Type of Bill with a Frequency Code 7 (field 4) and claim number in the Document Control Number (field 64). Enter all required data. All patient details are required (ID number with prefix, last name, first name, and date of birth).

Wps corrected claim form 2025

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