Provider Central

Please share this communication with your billing department or billing agency.

We’ve been requiring you to submit replacements to correct previously submitted CMS-1500 and UB-04 claims for several years. We'd like to remind you about specific scenarios where you cannot follow this process.

Reminder of when not to use replacements

You cannot use replacement claims to:

1. Change or correct the:
   • Billing NPI
   • Date of service (when it falls outside the original date span)
   • Level of care (inpatient to outpatient, or vice versa)
   • Subscriber ID
2. Submit an appeal or review (examples: timely filing, individual consideration)
3. Change a bridged admission claim
4. Correct a claim that was part of a previous recovery or audit
5. Correct BlueCard claims that denied for referral or authorization

Please use replacement claims for all other corrections.

Resources

• Replacement claim requirement frequently asked questions (recently revised)
• Checking claim status (new)
• Payspan quick start guide (recently revised)
• How to correct rejected claims

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