Replacement Claims / Recoupement


Medicare claims are cancelled directly in DDE.

Medicaid claims, however, may be replaced directly from Barnestorm. Each Medicaid claim sent for each patient has a unique identifying number, called an ICN.

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.

Here are the steps to replace a Medicaid claim:

Verify ICN Information

Go to Accounts Receivable > ICN Edit.

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

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. 

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:

 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#)