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.
Director, Network Operations