While Point32Health accepts electronic, online, and paper corrected claims for our Tufts Health Plan Senior Products (Tufts Medicare Preferred HMO/PPO and Tufts Health Plan Senior Care Options), we would like to remind our provider network that electronic submission is the preferred method for efficient and timely claims processing.
A corrected claim is a replacement of a previously submitted claim (e.g., changes or corrections to charges, clinical or procedure codes, dates of service, member information) — it is not an inquiry or appeal.
We strongly recommend submitting corrected claims electronically to save time and money and help expedite claims processing.
Providers who submit claims through electronic data interchange (EDI) should submit corrected claims via EDI in the HIPAA-compliant 837 format.
When doing so, please include the original claim number in the Original Reference No. field. You can find the original claim number in the remittance advice you received for the original claim.
To submit a corrected facility or professional claim via EDI:
- Enter the frequency code (third digit of the bill type for institutional claims; separate code for professional claims) in Loop 2300, CLM05-3 as one of the following:
- 7 (corrected claim)
- 5 (late charges)
- 8 (void or cancel a prior claim)
- Enter the last 8 digits of the original claim number in Loop 2300, REF segment with an F8 qualifier.
- For example, for claim #000123456789, enter REF*F8*23456789.