Corrected Claims - Quick Reference Guide
Instructions for the Submission of Corrected Claims
If a provider has submitted a claim with incorrect or missing information (missing provider NPIs, submission of COB information, procedure, DRG or diagnosis codes, unit values, etc.), Sunflower Health Plan requires that providers submit a Corrected Claim.
Claims missing or denied for the following information must be corrected electronically or by sending a corrected paper claim (using the instructions below):
- Attending Provider Name and NPI (box 76 on a CMS UB-04 claim form) and/or,
- Ordering, Referring or Prescribing Provider Name and NPI (box 17b on a CMS1500)
*Note: Claims missing or denied for Attending, Ordering, Referring or Prescribing Provider may not be corrected using Sunflower Health Plan's Secure Provider Portal.
Providers needing to resubmit primary payer’s EOB must follow corrected claim process by submitting a corrected claim and attaching the primary EOB. If a new primary EOB is submitted and that EOB does not match the original claim, submit a corrected claim and primary payer EOB using one of the following methods.
Submit corrected claims electronically via your Clearinghouse using the values specified for the fields below:
CMS 1500 / Professional Claims:
- FIELD CLM05-3 = 7
- REF*F8 = Must contain the original claim number from the Explanation of Payment (EOP)
UB / Institutional Claims:
- FIELD CLM05-3 = 7
- REF*F8 = Must contain the original claim number from the Explanation of Payment (EOP)
All Paper Claims submissions should be free of handwritten verbiage and submitted on a standard red and white UB-04 or CMS1500 claim form. Any Uniform Billing (UB)-04 or CMS1500 forms received that do not meet the Centers for Medicare and Medicaid Services (CMS) printing requirements will be rejected back to the provider or facility upon receipt.
In addition to submitting corrected claims on a standard red and white form, the previous claim number should be referenced as outlined in the National Uniform Claim Committee (NUCC) guidelines.
Submit corrected claims to Sunflower Health Plan using the values specified for the fields below:
CMS 1500 / Professional Claims:
- Box 22
- Medicaid Resubmission Code = 7 for Replacement or 8 for Void/Cancel of prior claim (left justified)
- Original Ref No. = Must contain the original claim number from the Explanation of Payment (EOP)
UB / Institutional Claims:
- Box 4 = Must contain a Bill Type that indicates a correction, e.g., 0XX7
- Box 64 = Must contain the original claim number.
Omission of these data elements may cause inappropriate denials, delays in processing and payment. The printing requirements are outlined in the Medicare Claims Processing Manual Chapter 26 – Completing and Processing Form CMS-1500 Data Set (Pub.100-04).
Mail Corrected Paper Claims to:
Sunflower Health Plan
Attn: Corrected Claims
P.O. Box 4070
Farmington, MO 63640-3833
Submit corrected claims via the Secure Provider Portal.
NOTE: Claim Corrections are not available if the provider data on the first submission is different than the corrected claim submission. The term provider data includes the billing, performing, ordering, referring, attending, and prescriber information.
1. Click Claims at the top of the screen.
2. Select an individual paid claim to see the details.
3. The claim displays for you to correct as needed. Click Correct Claim.
4. Proceed through the claims screens correcting the information that you may have omitted when the claim was originally submitted.
5. Continue clicking Next to move through the screens required to resubmit.
6. Review the claim information you have corrected before clicking Submit.
7. You receive a success message confirming your submittal.
Timely Filing of Claims vs Timely Correction of Claims
- First-time claims must be received by Sunflower within 180 calendar days from the date of service (discharge date for inpatient or observation claims).
- When Sunflower is the secondary payer, claims must be received within 180 calendar days from the date of disposition (final determination) of the primary payer.
- Corrected Claims must be received within 365 days of the date of Sunflower's notification of payment or denial.
Please contact your provider network specialist if you are interested in training to use our secure provider Portal.