How do I correct a denied claim?
Quick Answer
First determine whether the claim needs a correction or a formal appeal — if information was missing or wrong, submit a corrected claim (frequency code 7). If you disagree with the denial, file an appeal. Fix the specific issue, resubmit, and track the claim to resolution.
Step-by-Step Instructions
Identify the denial reason
Read the CARC code on the ERA/EOB. Then read the accompanying RARC code(s) for additional detail. The CARC tells you the category of denial; the RARC tells you the specifics.
Determine: correction or appeal?
If the claim genuinely had an error (missing modifier, wrong diagnosis, incorrect demographic), submit a corrected claim. If you believe the claim was correct as submitted and the denial was wrong, file a formal appeal. Most denials are resolved via correction, not appeal.
Correct the error in your billing system
Fix the specific field or fields identified by the denial codes. Common corrections include adding a modifier, changing a diagnosis code, updating a provider NPI, or correcting a place of service code.
Submit as a corrected claim
Use frequency code 7 (replacement of prior claim) on the CMS-1500. Submit through your clearinghouse or payer portal. Do not submit as a new claim — this will trigger a duplicate denial.
Monitor and follow up
Set a 30-day follow-up timer. If no payment or response within 30 days, check the payer portal or call the payer. Document every follow-up interaction with the reference number, date, and representative name.
Common Mistakes to Avoid
Resubmitting the claim as a new claim instead of a corrected claim — triggers a duplicate denial.
Filing an appeal when the claim actually had an error — appeals are for disputes, not corrections.
Correcting the wrong field — always trace the denial back to the specific RARC code before making changes.
Not documenting follow-up calls — without documentation, you cannot prove timely follow-up.
Waiting too long to correct — corrected claims must be within the timely filing window.