Replacement Claims / Recoupment

Medicaid claims may be replaced directly from Barnestorm. Each Medicaid claim sent for each patient has a unique identifying number, called an ICN. An ICN is a 15-digit number that uniquely identifies one payment of one claim (NC Medicaid).

You need to create a replacement claim when the original claim that was transmitted was incorrect due to missing information or incorrect information (examples: the claim did not include a visit that was added to the system after the claim was sent, or the number of hours billed was incorrect).

Here are the steps to locate/manually enter the ICN/DCN/Claim Number required for all Replacement Claims:

 Verify ICN Information 

If the ICN you need to replace is not there, you can enter it manually using these steps:

  1. Click the Add a New ICN Entry line.
  2. Enter the information from your paper copy of the remittance advice: payment date, from date, through date, and ICN number.
  3. Click the Save button.
  4. Your ICN entry will now appear in the list; make a note of the from and through dates and continue the steps in this process.

 Create Replacement Claim
Note: You can create multiple claims in one batch.  The entire batch will need to have valid ICN's in the system and no existing filename.  Otherwise, a batch will not generate. 

 The 837 file has information regarding the UB04 claim:

 on the line starting CLM* , after the :: there is a number--

1 = original claim

7 = replacement claim (If there is no “7” then you have not created a replacement claim.)

8= void claim

 line after the CLM* has the ICN number

On the claim, itself, the TOB will show 0327 (top right corner of claim).

The 837 file has information regarding the CMS1500 claim:

 1 = original claim

 7 = replacement claim (If there is no “7” then you have not created a replacement claim.)

 8= void claim

REF*F8*1234567890 (represents the ICN#)