UB-04 corrections

Submit the entire claim with corrections

Submit your entire corrected claim, not just the line items that were corrected, following the processes below, by U.S. Mail or electronically. Faxed or emailed claims will not be accepted.

Corrected claims will pend, not deny as duplicate or redundant, without your needing to call or email us.

Resubmit it with the appropriate bill type, changing the frequency (third digit of the bill type, see below) to reflect the change.

If you are adding or changing clinical information on the claim, attach supporting documentation.

Accepted bill frequencies

  • 5 – Late charges only claim (see below)
  • 7 – Replacement of a prior claim 
  • 8 – Void/cancel a prior claim

Correcting electronic UB-04 claims

If you don't know where the 2300 loop or 2300 NTE ADD fields are in the form you use, contact your software vendor. If your software vendor has additional questions, direct them to call the EDI Helpline.

  1. Enter Claim Frequency Type code (billing code) 7 for a replacement/correction, or 8 to void a prior claim, in the 2300 loop in the CLM*05 03.
  2. To ensure we process the claim accurately, add a note explaining the reason for the resubmission in loop 2300 NTE (segment) ADD (Qualifier). For example: NTE*ADD* (changed CPT)
  3. Enter the original claim number in the 2300 loop in the REF*F8*.

Late charges

Frequency code 5 indicates a claim is submitted for additional charges after an admit-through-discharge claim or last interim claim has been submitted. This code is not intended to be used in lieu of an adjustment or replacement claim.

Corrected claims billed with frequency 5 instead of a frequency 7 may be denied.

Late charges for ACA plans

Bill a late charge claim using a frequency 7, indicating a replacement claim. Include all charges, not just the late charges. Members with these plans can be identified in Member Inquiry, Employer Group: MyPriority PPACA.

Submitting medical records

When you request an authorization, or a post payment appeal determination, you may need to send us medical records. Use your secure mailbox to send the forms to us via email or mail us a hard copy. To access your secure mailbox: 

  1. Go to your Priority Health account Mailbox.
  2. Click the Compose tab.
  3. In the "What is your message about?" field, choose Medical record submission.
  4. Use the Attachments field to browse to your documents and attach them.
  5. In the body of the email include: member name, DOB, member ID number, claim/DCN number, date of service, billed amount, and inquiry number, if you have one.
  6. If you are submitting an appeal; you must complete and attach the most current Priority Health appeal form and submit a detailed letter of appeal. For more information  on appeals access our Reviews and appeals requirements.

If you don't have a Priority Health provider account, request one now.

Claim correction deadlines and timely filing

Follow-up is required within one year of the date of service, including resolving all claim discrepancies. Corrected or augmented information received after that date will be automatically denied as the provider's responsibility.

Providers have 90 days from date of the original denial (if close to or beyond one year from date of service) to resolve payment discrepancies including submitting corrected claims. This does not include upfront rejected claims or other insurance adjustment EOBs.

  • If you don't complete follow-up within 90 days, any request will deny without appeal rights.
  • Corrected or augmented information received after that date will be automatically denied as the provider's responsibility.
  • Denials related to authorizations/medical necessity or coding/clinical edits still follow the filing limit rules.
  • Accidentally overlooking a claim or a response deadline does not justify an exception to this policy.

Medicaid claims

  • Claims must be processed within 45 days of when we receive them to comply with the Timelines of Claims Payment Public Act 187. 
  • We will notify you in writing of any problems or defects with your claim within 30 days; you will then have 30 days to correct and resubmit the claim.
  • You may re-submit claims under third-party liability (TPL) investigation after 180 days if no response is received from the member.

90-day grace period

When Priority Health or another payer makes or recovers payment near or after our filing limit, you have 90 days from the date on the EOB to submit the claim to us. Payment corrections from another health plan require the claim and EOB to be submitted to Priority Health.

  • Attach the EOB to the claim so we can verify the claim was submitted to us within the 90 days. 
  • If you don't complete follow-up within 90 days, any request will deny without appeal rights. 
  • Corrected or augmented information received after that date will be automatically denied as the provider's responsibility. 
  • Denials related to authorizations/medical necessity or coding/clinical edits still follow the filing limit rules. 
  • Accidentally overlooking a claim or a response deadline does not justify an exception to this policy.