Tips from the CareOregon Claims Department

Occasionally, you may need to submit a change or correct information on a claim after it has been processed. To ensure these claims are handled accurately and efficiently, we encourage providers to use the proper coding when billing on a UB-04 or to identify what changes have been made when submitting corrections on a CMS 1500 claim form.

UB-04
To identify these claims as a Corrected Claim, Replacement Bill, or Late Charge, CareOregon requires providers to bill with the correct three digit Type of Bill (TOB).

• If submitting a Late Charge, use a TOB ending in "5" (xx5).
• If submitting a Corrected or Adjusted Claim, use a TOB ending in"6" (xx6).
• If submitting a Replacement to a Prior Claim, use a TOB ending in "7" (xx7).
• Failure to specify the correct TOB could result in your claim submission being denied or processed incorrectly.

CMS 1500
Professional providers should identify a claim as being a Corrected Claim by stamping the claim image with “Corrected Claim.” To ensure these claims are handled accurately and efficiently, we encourage providers to also identify what corrections have been made. This information can be typed or written anywhere on the claim. Please be descriptive, because any additional information will be useful to help increase accuracy and timeliness. It may be necessary to indicate whether you consider the claim changes a Replacement Bill, Late Charge, or Adjustment of a Prior Claim.

A Note about Refunds
If your office notices an overpayment before CareOregon has a chance to request a refund, please do not send in a check. Instead, submit a corrected claim, and we will process the adjustment and request the refund at that time.