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Provider Manual

Corrected Claim or Adjustment Requests

Last Updated on July 08, 2020

Corrected claim requirements:

Corrected claims are required when facilities have found incorrect information was submitted on a claim or a charge(s) that need to be added or corrected.

For purposes of claims payment, Security Health Plan will not accept an addendum, amendment, correction, or late entry to a medical record dated after a claim denial date.  If an addendum, amendment, correction or late entry to a medical record is legally dated prior to a claim denial, it may be considered for claim payment.  

Here are some examples of when to submit a corrected claim:

  • Incorrect patient
  • Incorrect date of service
  • Incorrect provider
  • Incorrect billed amount
  • CPT/modifier changes

If payment has been made on previous claims and the corrected claim filing rules below are not followed claims will be denied as duplicate service.

CMS 1500: Corrections need to be submitted electronically with a frequency code of “7” or on a paper CMS 1500 claim form clearly marked as corrected. Security Health Plan will accept claims marked anywhere on the claim form as corrected or with “correction/resubmission” identified in box 19.

UB-04: Corrections need to be submitted electronically with a type of bill of XX7 or on a paper UB-04 claim form with type of bill XX7 in box 4. All late charges for UB claims must be consolidated into one claim for submission. If the late charges are received separately, they will be denied as a billing error.

Timely filing for corrected claims: Corrected claims or adjustment requests must be received within normal timely filing limits or 60 days from date of payment/denial/rejection.

A corrected claim is not needed in the following scenarios:

  • Original claim was denied in full by Security Health Plan
  • Medical records, primary payer information or other documentation needed, but no changes were made to the actual claim
    • Please note that Coordination of Benefit information and credits should be applied on electronic claims in appropriate loops and segments for original claim processing

Deletions, reporting a duplicate payment, or providing a refund:

When a refund needs to be made to Security Health Plan due to the deletion of a service or duplicate payment, a void request needs to be completed.

CMS 1500: Voids need to be submitted electronically with a frequency code of “8” or on a paper CMS 1500 claim form with an “8” in box 22, resubmission code, and the original claim number in “Original Ref No” box.

UB-04: Corrections need to be submitted electronically with a type of bill of XX8 or on a paper UB-04 claim form with type of bill XX8 in box 4.

Electronic Claims Submission:
Electronic Payer ID: 39045

Paper claims submission:
Security Health Plan 
Attn: Claims Department 
P.O. Box 8000 
Marshfield, WI 54449-8000
Fax: 715-221-9767