Commercial - Administrative Procedures |
Adjustments/Corrected Claims/Resubmissions
To ensure the Claims Department has adequate information to
process claim adjustments and corrected claims in an accurate and timely manner,
ConnectiCare requires that requests be submitted via the Claim Resubmission Request Form, found in section 14, Forms.
Adjustments (review of a claims processing error) — The provider requests that ConnectiCare
reconsider a denied claim or the amount paid based on the original claim
submission. An adjustment should be requested if the claim was not paid for all
reimbursable services or has been denied inappropriately for reasons such as
member eligibility, duplicate services, retroactive referrals and
authorizations, and retroactive contract changes. Adjustments may not be requested for services
denied due to claims payment policies. Refer to Administrative
Appeals within this section.
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ConnectiCare reserves the right to charge providers a $15 per
claim fee for high-volume (20 or more claims) bulk billing errors for
electronically submitted claims.
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Corrected Claims (review of a claims billing error) — The provider requests that ConnectiCare
reconsider a claim based on incorrect, new, or missing data that was not
submitted with the original claim. ConnectiCare may require clinical
documentation when corrected claims are submitted with modifiers that were
missing from the original claim.
The process for submitting adjustments, corrected claims, and
resubmissions is the same, as outlined below:
• Complete the Claim Resubmission Request Form.
• A completed Claim Resubmission Request Form is required when submitting paper claim adjustments.
• If submitting a request for a corrected claim, also attach a copy
of the corrected claim form (CMS 1500 or UB04).
• There is a 1-year adjustment limit from the date of the original
Explanation of Payment.
• Submit to:
ConnectiCare, Inc. & Affiliates
Claims Department - Adjustments
175 Scott Swamp Road
Farmington, CT 06032-3124
• Adjustments and corrected claims may
not be submitted electronically.
• Resubmission of claims that have not yet been paid may
be submitted electronically. ConnectiCare’s 180-day filing limit (from date of
service) applies.
