Corrected dental claims keep your dental billing accurate, compliant and on track for faster reimbursements.
They are an essential aspect of dental insurance billing, ensuring accuracy and compliance in patient care and practice management.
In this blog, we'll explore scenarios where filing a corrected claim is necessary, how it differs from filing an appeal, and how the submission process may vary by insurance company.
What is a Corrected Claim?
A corrected claim is a resubmitted dental insurance claim that addresses errors in the original submission.
These errors might include incorrect patient information, wrong procedure codes, or incorrect billing amounts.
Corrected claims are crucial for ensuring that insurance companies receive accurate information after they, or the dental practice submitting them, determines that incorrect data was provided.
Addressing them promptly and accurately helps in avoiding delays in payment and ensures compliance with dental insurance policies.
Managing complicated billing tasks like corrected claims can be overwhelming, which is why many practices are turning to outsourcing dental billing services to improve accuracy and efficiency.
Most insurance companies enforce strict timely filing limits, typically between 90 and 180 days, so submitting corrected claims promptly is essential to avoid denials.
When to File a Corrected Claim
Common Scenarios
- Typographical errors: If there is a mistake in patient details, such as misspelled names or incorrect policy numbers, a corrected claim should be filed.
- Incorrect procedure codes: If the wrong procedure code was submitted initially, leading to incorrect billing or denial, a corrected claim should be filed with the correct code.
- Misreported dates: If the date of service or another critical date was reported incorrectly, this should be rectified through a corrected claim.
- Incorrect provider information: If the provider's details, such as their NPI number or address, were submitted incorrectly, a corrected claim is necessary.
- Billing amount errors: If the charge amounts were inaccurately reported, a corrected claim should be submitted to adjust the billing.
For procedures like scaling and root planning, insurers may require specific documentation such as radiographs and detailed clinical notes to support the corrected claim.
Corrected Claim vs Appeal: Key Differences
Corrected Claim
A corrected claim is used to fix errors in a claim that has already been submitted. It is essential when the original claim contains incorrect or incomplete information.
The goal is to correct the mistake and resubmit the claim for accurate processing.
Appeal
An appeal, on the other hand, is filed when a claim has been denied or partially paid, and the dental practice believes the denial or payment was incorrect.
The appeal process involves providing additional documentation or explanation to support the case that the original claim should be paid differently.
Understanding how corrected claims differ from initial submissions is only one part of the picture - knowing when dental billing crosses into medical billing is just as important for getting claims paid correctly.
Appeals are also appropriate when the original claim was denied due to missing or misunderstood documentation, even if the submitted information was correct.
How to Submit a Corrected Claim
General Submission Guidelines
When submitting a corrected claim:
- Identify the original claim: Clearly indicate that the new submission is a corrected claim by referencing the original claim number.
- Label as “corrected claim”: Use the appropriate notation (often “Corrected Claim” or “Resubmission”) on the claim form or in the electronic submission.
- Provide corrected information: Ensure that all errors are corrected in the new submission, and all necessary information is accurately provided.
- Include supporting documentation: Attach any supporting documents that justify the corrections made, such as notes explaining the change or updated patient
records. Include any other supporting documentation that supports the treatment, even if you submitted it initially on the incorrect claim.
Variations by Insurance Company
Submission requirements for corrected claims can vary by insurance provider:
- Electronic Submissions: Some insurance companies require corrected claims to be resubmitted electronically through a specific portal or clearinghouse. It's important to follow their specific guidelines for labeling and submission.
- Paper Submissions: Other companies may require paper submissions with the corrected claim form. Always use the designated form provided by the insurance company and ensure that it is filled out accurately, with all requested accompanying information. Be mindful of the mailing address, it may differ from the customary claims submission, or appeals address.
- Timely Filing: Insurance companies may have different time frames within which corrected claims must be submitted. It's essential to be aware of these deadlines to avoid denials.
Corrected Claim Form: Do You Need One?
Short answer: sometimes. It depends on how you submit and the payer’s rules.
- Electronic submissions
- You typically resubmit the original claim with a “Corrected Claim” indicator, not a separate form.
- Include the original claim number and a brief note explaining the correction.
- Use the appropriate claim frequency/replacement code your clearinghouse supports (e.g., replacement/corrected claim) and follow payer-specific tags or loops.
- Paper submissions
- Use a new ADA Claim Form (2019/2024), clearly marked “Corrected Claim” at the top.
- Reference the original claim number and date of service.
- Correct the fields, and attach supporting documentation (chart notes, X‑rays, perio charting, narratives).
- Some payers require a corrected claim cover sheet - check their provider manual.
- Payer-specific variations
- A few insurers require their own corrected claim form or a cover letter and may use a different mailing address than standard claims.
- Verify timely filing windows for corrections; they can differ from initial claims and from appeals.
Track corrected claims separately from new claims and appeals to ensure follow-up within 14 - 21 days.
Best Practices for Corrected Claims Filing
- Double-Check Before Submission: Always review claims thoroughly before submitting to minimize the need for corrections later.
- Stay Informed on Payer Requirements: Keep up-to-date with each insurance company's specific guidelines for corrected claims, as these can change over time.
- Track Claims: Use practice management software to track claims and ensure that corrections are submitted within the required timeframe.
- Communicate with Insurers: When in doubt, reach out to the insurance company for clarification on how to submit a corrected claim.
If a corrected claim is not yet on your over 30 days insurance aging report, ensure you are tracking it on a corrected claim, and/or appeals in progress list to ensure it stays on your radar.
Corrected claims filing is a vital part of the dental billing process.
By understanding when and how to file corrected claims, dental practices can ensure accurate billing and avoid unnecessary delays in payment.
Whether dealing with typographical errors or incorrect procedure codes, following best practices for corrected claims submission will help maintain smooth and efficient operations.
Join the growing number of dental practices that rely on Wisdom to keep claims clean, cash flow steady, and stress levels low.
