Corrected Claims Policy Change

Beginning October 1, 2021, CareOregon/Health Share of Oregon, Jackson Care Connect, Columbia Pacific CCO and CareOregon Advantage will acknowledge corrected claims only when billed appropriately. In the past, CareOregon has accepted and processed corrected claims if the term “CORRECTED CLAIM” was handwritten or typed on the claim form. Effective October 1, 2021, claims with handwritten or non-standard memos added will no longer be accepted. This change will apply to all Medicaid and Medicare claims for medical and behavioral health.

Corrected claim submissions must contain the proper coding for the claim form being submitted. Failure to submit corrected claims accordingly will result in unnecessary and inaccurate claim processing, such as denying the claim as a duplicate. Handwritten claims are strongly discouraged, as this causes delays in claim processing. The optical character recognition (OCR) software may not recognize non-standard fonts. Additionally, handwritten claims are known to have increased data error rates, which impacts accurate claims payment.

Providers are expected to submit all claims for services rendered, including corrected claims, using valid code combinations from Health Insurance Portability and Accountability Act (HIPAA) approved code sets. Claims should be coded appropriately, using industry standard coding guidelines.

A corrected claim is used to update a previously processed claim with new or additional information. A corrected claim is member- and claim-specific and should only be submitted if the original claim information was incomplete or inaccurate. Corrected claims must include all codes for services that were performed, as well as the correction. A corrected claim does not constitute an appeal.

Corrections must be billed according to the guidelines for the claim form being used. Please see table below:

CMS-1500

Use box 22. Enter 7 under Resubmission Code, and list the claim number under Original Ref. No.

UB04

Use box 4. A Bill Type of xxx7 or xxx5 indicates the claim is a replacement of a prior claim.


If you have questions, please contact Provider Customer Service at 800-224-4840, option 3.

Claims Director, CareOregon