Claims
Claim corrections
Two different situations. A claim the clearinghouse rejected never reached the payer, so you fix it and send it again. A claim the payer denied was adjudicated, so you send a replacement that names the payer's own claim number.
Written for: Billing and RCM teams
A rejected claim
- A 999 or 277CA rejection returns the claim to Pending with the rejection recorded. No action is needed to reopen it.
- Fix the cause where it lives: the coverage (member id, payer id, policy holder) or the facility. The 837P is rebuilt from current records on every submission, so those fixes take effect.
- A wrong procedure code, units or amount on a line cannot be fixed in the product today: the claim's lines come from its charges, a charge on a claim cannot be voided, and there is no line editor. Raise it with your administrator before resubmitting.
- Submit it again from Insurance → Claims. It goes as an original claim.
A denied claim: send a replacement
ArkCloud RCM → Insurance → Denials → Reopen for correction
The same action is in the row menu of a Denied claim on Insurance → Claims.
- An administrator reopens the denied claim. It returns to Pending. Nothing is sent to the payer yet.
- Correct whatever caused the denial.
- Submit it. The claim file (837P or 837I) is sent as a replacement (frequency code 7) quoting the payer'sclaim number, which ArkCloud recorded from the 835 (CLP07) or, failing that, from the 277CA acknowledgement (REF*1K). If that number is missing, submission is refused - without it the payer would treat the replacement as a duplicate.
Frequency codes
| Field or control | What it means |
|---|---|
| 1 - Original | Every first submission, and a resubmission after a clearinghouse rejection. |
| 7 - Replacement | A claim reopened from Denied. |
| 8 - Void | An administrator uses Void claim on the claim's detail page, with a reason of at least 5 characters. The 837 is sent with frequency code 8 and the payer's claim number. Refused when the claim was never sent, the payer has given it no claim number, payer money is posted on it (that comes back through the payer's 835 reversal), or a secondary claim was billed from it. The claim becomes Void only when the 277CA accepts the void. |