Samaritan Health Plans will be able to accept corrected professional claims (HCFA) electronically beginning Sept. 17. Electronic(EDI)-corrected professional claims must be designated by the frequency code of 7 in loop 2300 CLM05-3 and the original claim number in loop 2300 REF02. Please note that these claims must include all original claim lines that you do not want to be removed.
Impact on Refunds
When this new process is in place, there will be some changes when a corrected claim produces a refund. Previously, Samaritan Health Plans mailed a refund request letter to the provider office and used a payment offset to recoup the funds if a refund payment was not received back after 60 days.
Starting Sept. 17, if a refund is owed back to Samaritan Health Plans due to a corrected claim, Samaritan Health Plans 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 sending EDI-corrected claims, please call the Claims EDI team at 541-768-7955.