Claims operating instruction
1. Purpose:
This claims operating instruction (COI) serves as an informational guide regarding Corrected (Replacement) Claim submission requirements for Curative (the Plan). Adherence to these guidelines ensures timely processing and helps avoid claim denials, delays, or improper payment.
2. Scope:
This COI applies to all in-network and out-of-network providers submitting corrected claims for services previously processed by Curative.
3. Definitions:
A Corrected Claim is a resubmission of a previously adjudicated claim that includes changes to the original submission, such as:
- Diagnosis or procedure code corrections
- Modifier updates
- Billed amount or unit changes
- COB (Coordination of Benefits) updates
- Rendering, billing, or facility information corrections
- Clinical/coding revisions (including DRG changes)
A Corrected Claim replaces the original claim in its entirety. It is not an appeal or a request for claim reconsideration. A corrected claim is member and claim specific and should only be submitted if the original claim information was incomplete or inaccurate. All changes must be submitted through electronic or paper submissions and not by calling the Plan.
4. Operating Instruction / Guidelines:
Corrected Claims Submission
Corrected claim submissions should be minimal. The Plan urges providers to submit claims once all charges are documented to reduce claim processing errors and duplicate filing. Corrected claims must still be filed within the timely filing deadlines defined in your provider contract or regulatory guidelines. Note, a correction to a prior claim may not be submitted until the original claim has been processed and the provider has been notified of the claim status.
When submitting a corrected claim, required information is needed to support the change(s) to an incorrect or incomplete claim submission previously processed. All accurate line items from the original submission must appear on the corrected claim along with the line items requiring a correction to avoid unintended refund/overpayment requests.
Refund/overpayment requests triggered by the corrected claim will not issue a Provider Refund Notification Letter, as the Provider’s submission of the corrected claim acts as the Provider/Payer notification. If processing of the corrected claim results in a refund/ overpayment, these changes will be shown on the Explanation of Payment and/or Remittance Advice.
In some cases, medical records may be requested to justify corrections to diagnosis codes, DRGs, procedure codes, medication units, modifiers, or other modifications. Examples of supporting documentation include, but are not limited to: medical records, copy of the original claim, and documentation reflecting a procedure was repeated on the same day. Medical records should only be submitted upon request.
Corrected Claims for Late Charges
Late charges, or additional charges, represent changes for items and services that were submitted after the bill was created and not included in the original bill. All late charges must be submitted as a corrected claim after the original claim has been processed. When submitting a corrected claim to add late charges to an inpatient or outpatient claim submission of the entire claim (original values and late/additional charges) should be resubmitted with frequency code 7 (Replacement of Prior Claim). Do not submit a corrected claim using frequency code 5 (Late Charges). If the corrected claim is submitted using frequency code 5 this could result in a denial of the claim.
Electronic Submission
The Plan’s claim system recognizes electronic claim submissions by the frequency code. The ANSI X12 837 claim format permits changes to claims that were not included on the original adjudication. The 837 Implementation Guides refer to the National Uniform Billing Data Element Specifications Loop 2300 CLM05-3 for explanation and usage. In the 837 formats, the codes are called “claim frequency codes”. All corrected claim submissions should contain the original claim number or the Document Control Number/DCN (see Table below).
Paper Submission
When submitting a paper claim, Professional providers should use Form CMS-1500 (version 08/05) and Institutional providers should use Form UB04. Frequency codes for CMS-1500 Form box 22 (Resubmission Code) or UB04 Form box 4 (Type of Bill) should contain a 7 to replace the frequency billing code (corrected or replacement claim), or an 8 (Void Billing Code). All corrected claim submissions should contain the original claim number or the Document Control Number. Note: The Plan requires an NPI number and paper claims may be denied if filed with only the Plan’s provider number. Paper claims that are rejected / denied will be returned with a cover letter explaining the reason for return. Providers can obtain additional information about the CMS-1500 claim form by visiting the National Uniform Claim Committee website.
| FREQUENCY CODE | DESCRIPTION | SUBMISSION GUIDELINES | ACTION |
| 7 - Replacement of Prior Claim | Use when replacing the entire claim - DO NOT only send changed lines. | File the claim in its entirety, including all services for reconsideration. Include a brief description of the correction being made in the Remarks Field | The Plan will adjust the original claim. The corrections submitted represent a complete replacement of the previously processed claim. |
| 8 - Void/Cancel of Prior Claim | Use to entirely eliminate a previously submitted claim for a specific provider, patient, insured and “statement covers period.” | Include all charges submitted on the original claim. The following is required information and must match the original paid claim: • Patient’s last name, first initial • Member ID number • DCN number • Claim change reason code(s) or condition code(s) • Reason for voided or cancelled claim in the Remarks field and the dates of service to be cancelled | The Plan will void the original claim from records based on this request. This will result in recovery of any paid amounts. |
5. Procedure
Electronic replacement claims submitted with claim frequency code 7 or 8 with the original claim number must be submitted in Loop 2300 REF02- Payer Claim Control Number with qualifier F8 in REF01. Failure to submit without the original claim number will generate a compliance error and the claim will be rejected. The Plan will only accept claim frequency code 7 to replace a prior claim or 8 to void a prior claim.
- Additional Information for Professional Providers/ Electronic Submissions A claim correction submitted without the appropriate frequency code will be denied and the original claim number will not be adjusted.
- Additional Information for Institutional Providers/Electronic Submissions A claim correction submitted without the appropriate frequency code will be denied as a duplicate and the original claim number will not be adjusted.
Refer to the Plan’s website for the benefits of submitting claims electronically.
6. Reference Documents and Materials
Curative Correct Coding Guidelines Policy
National Uniform Claim Committee www.nucc.org
Revision history:
- Date: 11/15/2025
- Author: Curative Claims
- Comments: Initial Version