May 23, 2022
Area(s) of Interest: Payor Issues and Reimbursement
Physicians are reminded that Medi-Cal provides an electronic method to resolve a claim denial or incorrect payment for 837I (Institutional) and 837P (Professional) claims. By resubmitting the claim with either frequency type code “7” (replacement of prior claim) or “8” (void/cancel of prior claim), physicians can avoid adjusting claims using the paper Claims Inquiry Forms (CIFs) or Appeal Forms with accompanying Remittance Advice Details (RADs) to show proof of previous claim payment or denial.
Electronic replacement claims must be submitted within six months of claim payment or denial. Physicians may submit an electronic follow-up claim even if the original was a paper claim. Replacement and void claims can be sent in the same batch as new claims.
Do NOT electronically resubmit claims for which a CIF or appeal is already in progress, as such claims will automatically be denied and may delay any processing of the claim.
For more information on the Medi-Cal electronic claim resubmission process, please see the April 2022 Medi-Cal Update.