Resubmission Code & Claim Reference Number
What’s in the box?
This box is used to inform an Insurance company that the claim in question has been previously filed. This box has space for two pieces of information:
Resubmission Code (aka Claim Frequency Type Code)
- Used to indicate if the submission is a corrected claim (6), replacement of prior claim (7), or if it’s meant to void a previous claim (8).
- If this box is left empty, this means the claim is an original submission.
- Left blank by default on the CMS1500.
Reference Number (aka Claim Control Number)
- This number is assigned by the Insurer when processing the original claim— it can sometimes be found on the remittance for the original claim.
- Left blank by default on the CMS1500.
📍 Pro Tip: Every Insurance company has its own procedure for receiving resubmissions. For example, some only allow for a specific Resubmission Code. If you’re unsure how to format a resubmission, it’s best to contact the Insurer to confirm their resubmission guidelines.
Where does this info live in Jane?
When you generate an electronic submission for a claim for the first time, Jane won’t ask you if the claim is a resubmission. The claim will be submitted as an original claim by default.
However, if you have already generated an electronic submission for a claim, and you head to the EDI pre-flight view to create a second submission, you’ll see a new section:
By default, additional submissions will still be treated as original submissions, but you can select one of the resubmission options from the dropdown to change that.
📍 Pro Tip: Setting a Resubmission Code and Control Number in the EDI Pre-flight will also affect the CMS1500. That said, it might be easier for you to just add this info manually to Box 22 if you are submitting paper claims.
Note that if you check out a claim’s submission history in the EDI pre-flight view, you can see whether or not the claim was submitted as an original claim or a resubmission.
Is this required?
Insurance companies dictate resubmission requirements. In Jane, adding resubmission info to box 22 is optional.
What about the EDI file?
Resubmission information is sent in Loop 2300 - Claim Info.
- The Claim Frequency Type Code is sent in Loop 2300, Segment CLM05-03. Here is a list of possible Type Codes that can appear in this sub-element:
- Original claim - (1)
- Corrected claim - (6)
- Replacement of prior claim- (7)
- Void a previous claim- (8)
- The Claim Control Number is sent in Loop 2300, Segment REF
- REF01 contains the qualifier F8, which means Original Claim Reference.
- REF02 contains the actual control number.