
Pacificsource Corrected Claim Form


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Quick guide on how to complete pacificsource corrected claim form
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People also ask
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How do I send a corrected claim to Medicare?
To submit a corrected claim to Medicare, make the correction, and resubmit it as a regular claim (Claim Type is Default) and Medicare will process it.
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How do I submit a claim to PacificSource?
Email: CS@PacificSource.com. Fax: 541-225-3632. Mail: PacificSource Health Plans, PO Box 7068, Springfield, OR 97475-0068.
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What is the difference between UB-04 and 1500 claim form?
In general, the UB-04 form is used by institutional healthcare providers, such as hospitals, nursing homes, and rehabilitation centers, while the CMS 1500 form is used by individual healthcare providers, such as physicians, therapists, and dietitians.
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What is code for corrected claim?
Professional Claims For replacement or corrected claim enter resubmission code 7 in the left side of item 22 and enter the original claim number of the claim you are replacing in the right side of item 22.
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What is a corrected claim form?
A corrected claim is a replacement of a previously billed claim that requires a revision to coding, service dates, billed amounts or member information.
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What is a corrected claim?
A corrected claim is a replacement of a previously submitted claim (e.g., changes or corrections to charges, clinical or procedure codes, dates of service, member information, etc.). A corrected claim is not an inquiry or appeal.
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What is claim resubmission?
A "Resubmission" is defined as a claim originally denied because of missing documentation, incorrect coding, etc., which is now being resubmitted with the required information.
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What is the tob for a corrected claim?
Go to the Type of Bill (TOB) field (FL04) and replace the third digit to "7". Proceed to enter the Document Control Number (DCN) or Claim Number field (FL64) for the corrected claim. Click the button at the top of the screen. This will resubmit it as a corrected claim.
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