After submitting claims to a payer, sometimes a corrected claim needs to be created. You'll be alerted to claims needing correction electronically through the clearinghouse by a claim rejection, from a portal (such as Availity), by calling the payer, or by payer correspondence sent through the mail.
There are a few ways to send out a corrected claim in AveaOffice, this article includes how to correct or resubmit a claim and locate rejected claims.
The most common approach to correcting claims is to change the requested information for the patient or claim in AveaOffice, then navigate to the Review Corrections tab. Common updates include changes to the patient or service information.
After the information has been changed, use these steps to correct the claim:
- Navigate to the Patient Profile > Treatment Episode > Insurance Billing > Review Corrections.
- Click Check for Corrections.
- Locate the claim in the claim corrections list and click Compare.
- Any changes to information since the claim's original submission will be highlighted in red, with the original claim value displaying on the left and the new value displaying on the right.
- Avea automatically updates the Type of Bill suffix field to a 7 for any claims that have been previously submitted to and accepted by the payer. The 7 bill type suffix indicates that this is a corrected claim.
- If the claim did not make it to the payer (for example, it was rejected at the clearinghouse) you will see a 1, 2, 3, or 4 suffix.
- You'll see an 8 suffix if the claim needs to be voided. This occurs when the treatment was removed from the Attendance calendar.
- After comparing the claims to make sure the changes you made to the information appear on the claim, click Close.
- Click Resolve.
- Select Create Corrected Claim.
- Enter the Internal Control Number.
- If the claim never made it to the payer (rejected at the clearinghouse) and doesn't have an Internal Control Number, enable to Submit as New Claim toggle to bypass the ICN requirement.
- If you need to add populate Box 80 on the institutional claim with remarks, you can enter those in the Remarks field.
- Select the Claim Issue Source.
- Select the related Claim Issue Type.
- For Institutional claims, you can include condition codes as needed using the Available Codes drop-down. This is a hardcoded list of the most commonly used codes for Behavioral Health.
- Select Resolve and Go to Submit Claims to go directly to the Submit Claims page or click Resolve to address additional corrections for this patient.
Create Corrected Claims
The corrections generator is a system task that automatically runs each night and compares the submitted claim data to the data present in Avea. Any claims with data changes since the original claim submission will be flagged in the Patients Claim Correction Pending tile of the Organization Dashboard and will be placed in the Corrected Claims tab (Work Center > Insurance Claims).
- Just like working the correction from the patient's treatment episode, we recommend reviewing the corrections by clicking on the (Compare) link to see what the suggestions are.
- The Claim Value column is the originally submitted values and the Current Value column is the suggested corrections. Differences are highlighted in red.
- You will always see that the Claim Instance ID changed by one iteration (-1.2, -1.3, etc), to indicate the new version of the claim.
- Also, more likely than not, the bill type suffix for the claim will also change to the 7 correction claim bill type.
Resubmitting a Claim with No Changes
You can also resubmit a claim with no changes, as itemized, or as a paper claim. This is completed from the patient's treatment episode.
- Navigate to the Patient's Profile > Treatment Episode > Insurance Billing > Claims.
- Locate the claim.
- Choose Resubmit on the left-hand side of the claim.
- Choose No Changes or Itemize Treatments.
- Select the Resubmission Source and Issue Type.
- Click Create.
Click here for instructions on managing rejected claims.