Understanding corrected claims in dental insurance billing

Corrected claims 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.

Table of Contents

1. What is a Corrected Claim?

2. When to File a Corrected Claim

3. Corrected Claim vs. Appeal: Key Differences

4. How to Submit a Corrected Claim

5. Best Practices for Corrected Claims Filing

What is a Corrected Claim?

A corrected claim is a resubmitted 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 corrected claims promptly and accurately helps in avoiding delays in payment and ensures compliance with dental insurance policies.

When to File a Corrected Claim

Common Scenarios

Filing a corrected claim is necessary in the following situations:

1. Typographical Errors: If there is a mistake in patient details, such as misspelled names or incorrect policy numbers, a corrected claim should be filed.

2. 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.

3. Misreported Dates: If the date of service or another critical date was reported incorrectly, this should be rectified through a corrected claim.

4. Incorrect Provider Information: If the provider's details, such as their NPI number or address, were submitted incorrectly, a corrected claim is necessary.

5. Billing Amount Errors: If the charge amounts were inaccurately reported, a corrected claim should be submitted to adjust the billing.

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.

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.

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.

Expert Tip: 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.

‍