This revision includes many important additions, including –
- Replacement / Corrected Claims Procedure
The Quartz Provider Manual now includes a recommendation that replacement / corrected claims be sent via EDI submission.
- A 837 format should be used for these claims.
| Code | Description | Claim Type | Filing Guidelines | Action |
|---|---|---|---|---|
| 7 | Replacement / Correction of Prior Claim | Professional or Institutional Claim | File electronically, as normal. File the claim in its entirety, including for all services for which you are requesting reconsideration. This would include additional charges. Include the original Quartz claim number in REF02 field. | Quartz will adjust the original claim. The corrections submitted represent a complete replacement of the previously processed claim. |
- A specific claim number format should be used
When submitting claims noted with claim frequency code 7, the original Quartz claim number must be submitted in Loop 2300 REF02 – Payer Claim Control Number with qualifier F8 in REF01. The Quartz claim number can be obtained from the 835 Electronic Remittance Advice (ERA) or Paper Remittance Advice.
The ANSI 837 CLM segment containing the Claim Frequency Code 7, along with the required REF segment and Qualifier in Loop ID 2300 example is below:
Claim Frequency CodeCLM*12345678*500***11:B:7*Y*A*Y*I*P~ REF*F8*(Enter the Quartz Claim Number); the REF02 value noted under filing guidelines |
For more information, refer to page 29 in the Quartz Provider Manual.
New and Updated Policies
- Added:
- Policies for modifiers
- AE (Registered Dietician),
- AK (Non-Participating Physician) and
- GF (Non-Physician Services Provided in a Critical Access Hospital)
- Policies for modifiers
- Updates to policies throughout
Please review these policies to make sure you have the most up-to-date information.
