Important Replacement Claim Billing Reminders

Harvard Pilgrim would like to remind providers of some key points regarding the correct billing of replacement claims. A replacement claim must completely replace the entire original claim; the information on the replacement claim voids and replaces the previously submitted claim.

If you have omitted charges or changed information on a claim — such as diagnosis codes, dates of service, or member information — you must submit the entire claim as a replacement claim using type of bill frequency code 7 and include all the previous information, as well as any corrected or additional information. Please note that a replacement claim submitted without type of bill frequency code 7 may be considered a duplicate and consequently denied.

It is also important to note that replacement claims must be submitted within 90 days of the date of the first claim’s explanation of payment. As a reminder, replacement claims are accepted electronically. For complete information, please refer to Harvard Pilgrim’s commercial Replacement Claim Billing Payment Policy.

Publication Information

Helen Connaughton,
Director, Network Operations

Annmarie Dadoly,

Joseph O’Riordan,

Kristin Edmonston,
Production Coordinator