There are few things more frustrating for a private practice than seeing a claim denied. It’s a direct hit to your cash flow and a time-consuming administrative headache. But a denial doesn’t have to mean lost revenue. More often than not, it’s a correctable error.
The key to getting paid is understanding how to communicate the correction to the payer. Simply sending a new claim will almost certainly result in a duplicate denial. Instead, you need to use the official resubmission code for the corrected claim to signal that you are replacing a previous error.
In this guide, we’ll break down the codes you need to know, when to use them, and how to prevent these denials in the first place.
First, Understand Why Your Claim Was Denied
Before you can fix a claim, you must understand what was wrong with it. Your Explanation of Benefits (EOB) or Electronic Remittance Advice (ERA) is your roadmap. Look for the denial reason codes and descriptions. Common errors include:
- Incorrect patient demographic information
- A missing or invalid CPT or ICD-10 code
- Lack of a required modifier
- Services not covered under the patient’s plan
Once you’ve identified the error, you can decide on the right course of action.
The Core of the Solution: The Corrected Claim Code
For most common errors, your goal is to replace the original, incorrect claim with a new, accurate one. This is where the resubmission code for the corrected claim comes into play.
What is the Official Corrected Claim Code?
The industry-standard corrected claim code is Claim Frequency Code 7, which stands for “Replacement of a Prior Claim.”
When you use this code, you are telling the payer: “Disregard the previous claim I sent; this new version is the correct one.” You should use this corrected claim code for errors like typos, incorrect service dates, or wrong procedure codes. Using the proper resubmission code for corrected claim is the single most important step in this process.
To use it correctly on a CMS-1500 form, you must:
- Enter code 7 in Box 22 (Resubmission Code).
- Enter the original claim number from the payer in the “Original Ref. No.” field.
Forgetting that original reference number is a common mistake that leads to the corrected claim being denied as a duplicate.
When NOT to Correct: Understanding the Void Claim Code
What if the original claim should never have been sent at all? This is where a different code is needed. Trying to use a corrected claim code in this scenario will only create more confusion.
Decoding Resubmission Code 8
The code used to cancel a previously submitted claim is the void claim code, also known as Resubmission Code 8. This code tells the payer: “Completely cancel and ignore the claim I sent with this reference number. It was a mistake.”
You must use the void claim code in situations such as:
- A duplicate claim was sent by mistake.
- A claim was submitted for the wrong patient.
- A claim was submitted for a service that was never performed.
Just like with a correction, using Resubmission Code 8 requires you to reference the original claim number in Box 22. This ensures the payer voids the correct transaction. Failing to use the void claim code for a claim that needs to be cancelled can cause significant payment and reconciliation issues down the line. Using Resubmission Code 8 is the only proper way to retract a claim entirely.
Partner with Experts to Eliminate Denials
Manually tracking EOBs, identifying errors, and resubmitting claims with the correct resubmission code for corrected claim or void claim code is a drain on your practice’s time and resources. Every correction is a delay in your revenue cycle.
This is where Medical Billing Direct steps in.
Our team of billing and coding experts acts as an extension of your practice. We don’t just fix denials—we prevent them. By ensuring a 98% clean claim rate on the first submission, we drastically reduce the need to ever worry about a corrected claim code or Resubmission Code 8. We manage your entire revenue cycle, from credentialing and eligibility verification to aggressive follow-up on unpaid claims, so you can focus on what matters most: your patients.
Conclusion
Navigating the world of claim resubmissions requires precision. As we’ve covered, understanding the critical difference between the resubmission code for corrected claim (Frequency Code 7) and the void claim code (Frequency Code 8) is essential for a healthy revenue cycle. These codes are your direct line of communication to the payer, telling them whether to replace an error or cancel a mistake entirely.
While handling these corrections manually is possible, each denial represents a delay in payment and a drain on your administrative resources. The time spent deciphering EOBs, fixing errors, and tracking resubmissions is time not spent on patient care or practice growth.
Frequently Asked Questions
- What is the most common resubmission code for a corrected claim?
The most common and correct code is Claim Frequency Code 7 (Replacement). This is the official resubmission code for corrected claim used to inform payers that you are sending an updated version of a previously submitted claim. - When I use a corrected claim code, do I need to include the original claim number?
Yes, absolutely. In Box 22 of the CMS-1500 form, you must include both the corrected claim code (7) and the payer’s original claim reference number. Without the reference number, the payer’s system will likely see your correction as a brand-new, duplicate claim and deny it. - What is the difference between a resubmission and an appeal?
A resubmission (using a corrected claim code) is used to fix a clerical or billing error on a claim. An appeal is a formal process you initiate when you disagree with the payer’s decision to deny a claim that you believe was submitted correctly, usually due to a dispute over medical necessity or coverage policy.
Stop Chasing Down Denials. Start Maximizing Your Revenue
Let Medical Billing Direct handle the complexities of your billing cycle. We ensure accuracy from the start so you can get paid faster.