Corrected Claims: Cancellation vs. Replacement vs. Reinvoicing

 

 

Which option is best for the circumstance?  

 

Replacement  

If a claim was sent with incorrect data, such as a wrong rendering provider NPI, CPT code, referring doctor, etc., the claim should be replaced. This is because there is an expectation of payment from the same payer for the services rendered, even with the newly corrected data. Replacing the claim is much simpler than cancellation and resubmission as the claim replacement overwrites anything sent in the first claim.  

 

If this situation applies, follow the claim replacement instructions.  

 

 

 

Cancellation  

If a claim was sent but shouldn't have, the claim should be cancelled. Examples of an incorrect submission could be the wrong patient was billed or poor therapist documentation to support the claim. This is because there isn't an expectation of payment from the same payer because the claim was sent in error. Upon successful cancellation, the payer electronically sends back a negative charge to cancel out the payment.  

 

If this situation applies, follow the claim cancellation instructions. 



Reinvoicing

If you need to change the payer on a claim that has been accepted by the wrong payer, this requires a claim reinvoicing. You may also need to reinvoice a claim if you need to switch the coordination of benefits order (e.g., primary to secondary, or secondary to primary).

If this situation applies, follow the claim reinvoicing instructions.