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).

IMPORTANT: if the claim rejected and did not pay, then just build a new claim and send it--replacement is not needed when the claim doesn't pay at all.

NOTE: These same steps can also be done for other payers (Medicare, HMOs, BCBS etc); however, the ICN/DCN format may be different dependent on the payer. Some payers may simply call this the "claim number."

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

Verify ICN Information

Go to Accounts Receivable > ICN Edit.
Enter the patient's chart number.
If the patient has more than one payer, select the payer.
The ICNs are listed on the right, showing From Date, Through Date, Paid Date, and ICN number. Determine which ICN needs to be replaced based on the dates. Make a note of the from and through dates.
If the dates you need to replace are NOT listed, follow steps below.

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

Click the Add a New ICN Entry line.
Enter the information from your paper copy of the remittance advice: payment date, from date, through date, and ICN number.
Click the Save button.
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.

Go to Billing > All Other Billing
Enter the from date and through date EXACTLY as they appeared on the claim you wish to replace.
NOTE: The software searches for the matching ICN by matching the chart#, Program, Payer, and date of the first visit. If after making your corrections your “from date” has changed, you may need to change the from date to the first visit date of the claim.
Enter the patient chart number.
Select Prepare Charges For Billing
****Check the box beside Send as Replacement Claims **** THIS STEP IS IMPORTANT****
Create HIPAA Tx.
Go back to Accounts Receivable > ICN Edit. You should see the batch number beside of the ICN number you just created a claim for.
Transmit to Medicaid as normal--the transmission process is exactly the same for a replacement claim as for a regular claim.
Advanced Information (Once you have created the transmission, pull up the claim in your claims folder):

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:

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

Only with a replacement claim will the following line appear in the 837 file. This line appears after the "CLM" line. Here is an example of what it will look like:

REF*F8*1234567890 (represents the ICN#)

On the claim, itself, the number 7 (or 8 if it's a void claim) and the ICN# will appear on the line beneath the ICD codes.