Institutional providers can now electronically submit late charges, corrected claims or a total replacement to a prior claim. These claims can be identified by the three digit Type of Bill (TOB), ending in ‘5’ for late charges, ‘6’ for corrected claims and ‘7’ for replacement claims (i.e. 115, 135, 116, 136, 117, 137). For electronic submissions, the TOB is located in Record 40, Field 04, Positions 25-27. For UB-92 paper claim submissions, the TOB is located in form locator Field 4.

Professional providers should submit late charges on a new claim. For corrected claims, a ‘C’ is required in field 10d on a CMS 1500 claim form.

Blue Choice ® PPO/POS Claims

Late Charge Claims

• If either an inpatient or an outpatient late charge (xx5) claim is filed, and a matching claim is found, then the original claim will be adjusted as a result, and the late charge claim will be denied stating that the original claim is being adjusted accordingly.
• If an inpatient late charge (xx5) claim is filed and no matching claim is found, then the late charge claim will be denied stating that we are unable to process because the original claim has not been received.
• If an outpatient late charge (xx5) claim is filed and no matching claim is found, then the late charge claim will be processed as an original claim.

Corrected or Replacement Claims

• If an inpatient or outpatient corrected (xx6) or replacement (xx7) claim is filed, and a matching claim is found, then the original claim will be reviewed and adjusted as a result, and the corrected/replacement claim will be denied stating that the original claim is being reviewed and adjusted accordingly.
• If an inpatient or outpatient corrected (xx6) or replacement (xx7) claim is filed, and no matching claim is found, then we will process the corrected/replacement claim as an original claim.

HMO Blue ® Texas Claims

Late / Corrected or Replacement Claims

• If the late charges or corrected claim would result in an additional payment and a matching claim is found, then the late charge/corrected claim will be paid and the original claim will be reversed (adjusted to zero-pay) at that time.
• If the late charges or corrected claim would result in a lesser payment and a matching claim is found, then the late charge/corrected claim is denied and the original claim will be reprocessed.
• If any late charge or corrected claim is filed and no matching claim is found, then the late charge/corrected claim is processed as an original claim.

To ensure that you can submit electronic late charges for corrected and replacement claims, please review your system edits with your vendor, billing service or clearinghouse. It may be necessary for your vendor to accommodate the filing of these claims. BCBSTX and THIN encourage you to take advantage of this change to increase the number of claims you can file electronically. This will reduce your administrative costs, save time, and increase claim accuracy in order to ensure faster reimbursement as compared to paper claims.

Revised: 11/05/2003.