Samaritan Health Plans is currently working to accept electronic-corrected professional claims (HCFA). A pilot project has been initiated with a small sample of provider offices currently billing through Change Healthcare (formerly Relay Health). Upon completion of the pilot, providers will be able to bill their corrected professional claims electronically. A corrected professional electronic claim must be designated by the frequency code of 7 in loop 2300 CLM05-3 and the original claim number in loop 2300 REF02.
When this new process is in place, there will be some changes when a corrected claim produces a refund. Today, Samaritan Health Plans mails a refund request letter to the provider office and uses a payment offset to recoup the funds if a refund payment has not been received back after 60 days. In the future, if a refund is owed back to Samaritan Health Plans due to a corrected claim, the reprocessing application will automatically set the refund owed to be taken via offset on the next payment made to the provider. If the corrected claim triggers an additional payment, the provider will receive that payment in the next check run following the completion of reprocessing.
For questions about electronically-corrected claims, please call the Claims EDI team at 541-768-7955.