7/31/2018
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Posted by Provider Relations
As previously communicated, Fidelis Care is no longer accepting corrected claims that are incorrectly billed. Providers submitting paper corrected claims to Fidelis Care must follow the Important Guidelines for Corrected Claims, which are available below.
• The Corrected Claims Form – Section 12B is no longer required to be submitted with your paper corrected claim. This form has been removed from the Provider Manual.
• Submitting Claims with Attachments - As a reminder, if a claim is being submitted with an attachment, please submit the claim form first with the attachment following the claim.
• If your corrected claim is not billed according to the guidelines below, your claim will not be accepted and will be returned.
Important Guidelines for Corrected Claims
Effective immediately, providers who are submitting paper corrected claims to Fidelis Care must follow the claim and field billing guidelines below.
• UB-04 Corrected Claims:
FL 04: Type of Bill field must be billed with a code ending in “7”, and
FL 64: Document Control Number field must be billed with the Fidelis Care original claim number.
• CMS-1500 Corrected Claims:
FL 22: Resubmission Code field must be billed with a “7” and the Original Reference Number field must be billed with the Fidelis Care original claim number.
