The Process of Modifying Medical Claims

After submitting a medical claim, it may be possible to make changes, but the process and permissibility of doing so depend on the specific circumstances and payer rules. If the claim contains errors or inaccuracies, it is typically possible to correct and resubmit the claim with accurate information. The payer will generally require supporting documentation, such as a corrected billing form after the claim is “completed.”

If the claim is denied, there is a possibility of submitting additional documentation to support the appeal. It is important to note that the appeal process can vary from payer to payer, so providers should familiarize themselves with the guidelines of their specific payer.

Providers should be mindful that any changes or corrections to a claim should be made as soon as possible after the error is identified, regardless of the situation.

What is a corrected claim?

A corrected claim is a type of medical claim that is submitted to correct errors or inaccuracies in a previously submitted claim. It is used when a provider or patient discovers an error in a claim that was already submitted to an insurance company or payer. This can happen for various reasons such as incorrect patient information, wrong codes, missing or incorrect signatures, and others.

Corrected claims are typically submitted with the corrected information and any supporting documentation that is needed to explain the changes. The corrected claim should include enough information for the payer to identify the original claim and the reason for the correction.

When a corrected claim is submitted, the insurance company will review the new information, process the claim and notify the provider of their decision. In case the corrected claim is denied, a provider may have the option of appealing that decision.

Keep in mind that submitting corrected claims can delay the payment and sometimes extra documentation is required to process the corrected claim. Therefore it is important to ensure that the initial claim is as accurate and complete as possible, to avoid the need for corrected claims and delays in payment.

What can be fixed on a corrected claim

A corrected claim can be used to fix a variety of errors or inaccuracies in a previously submitted claim. Some common examples include:

Incorrect patient information

This can include errors such as incorrect name, date of birth, or insurance information.

Incorrect coding

This can include errors such as using the wrong diagnostic or procedure (service) codes, or incorrect billing information.

Missing or incorrect signatures

This can include errors such as missing signatures or incomplete authorizations on the claim form.

Incorrect service date

This can include errors such as incorrect date of service or date of discharge on the claim form.

Incorrect charges or Fees

This can include errors such as missing or incorrect charges for services rendered or additional fees not covered by the insurance.

Insufficient documentation

This can include errors such as missing medical records, radiology films, or diagnostic results that are necessary to support the claim.

It’s important to note that a corrected claim should only be submitted for errors that will change the outcome of the original claim. A corrected claim should not be submitted to change the diagnosis or service that was rendered and previously billed.

Submitting “corrected” claims electronically to insurance

Corrected claims may be submitted electronically through your EHR, such as SimplePractice or TherapyNotes.

Medical Billing Service supporting Mental Health providers

At MCM South Medical Billing Service, LLC, we understand the importance of ensuring that your medical claims are accurate, complete, and timely submitted. We work with various providers, including psychiatrists, psychologists, clinical therapists, and female therapists with specialties such as LPC, LMFT, LCSW, Ph.D., and Psy.D to ensure that their claims meet the specific payer guidelines.

Services

– Comprehensive medical billing service

– Patient insurance benefits verification (offered as a standalone service)

Know your patient’s benefits

Co-payment (co-pay), deductible amount, deductible accumulations, co-insurance, and (OOP) out-of-pocket maximum

Our therapists specialize in various areas, including anxiety, trauma, cognitive-behavioral therapy, child behavior, couples therapy, family therapy, play therapy, sports therapy, ADHD, and psychological testing. By providing comprehensive billing services, we can help providers focus on their areas of expertise while ensuring that their claims are submitted accurately and efficiently.