Resubmitting a Claim

Unfortunately, claim denials are a normal part of the billing process. The important thing to do is be prepared — claim denials and billing errors happen. A claim might need to be resubmitted due to common reasons such as: incorrect coding, missing required information, inadequate documentation, lack of "medical necessity", incorrect patient details, not having proper authorization for the service, filing the claim past the deadline, or the service not being covered by the patient's insurance plan.

If you need to make revisions or adjustments, and resubmit a claim; you can do so by opening the claim in Doulado and clicking revise at the top right of the submitted claim. Instead of creating an entirely new claim, you can revise a submitted claim in Doulado, but it's generally best to wait to modify a submitted claim until you hear back from the payer with some more information.

Before resubmitting a claim, you may want to wait until you hear one of these things:

• If the claim is rejected by the payer, then you can revise, make any modifications, and re-submit
• If the claim is denied by the payer (and you receive an EOB indicating a $0 or underpayment), you can revise the claim, make any modifications, and add the resubmit code and payer claim ID to box 22)

Common Resubmit Codes

• 6-Corrected: A corrected claim
• 7-Replacement: A replacement for a previous claim
• 8-Void: A void for a previous claim

Payer Claim ID

Also known as the Claim Control Number or ICN, this number is assigned by the payer when processing the original claim. This number can typically be found on the EOB (Explanation of Benefits), usually near the top of the document. 

Payer requirements

Different payers may have different requirements for resubmission codes and reference numbers. You can contact the payer directly to determine their preferred resubmission code and reference number.