You can submit a corrected, replacement, or voided claim electronically using the HIPAA 837 standard claims transaction. Please include the following information:
- Frequency code of '7' in loop 2300, CLM05-3 segment to indicate a corrected/replacement of a previously processed claim. Use '8' to void a claim you billed in error.
- The initial Premera claim number (in loop 2300, REF01 must contain 'F8' and REF02 must contain the claim number).
- A free-form note (highly recommended) with an explanation for the corrected/replacement claim, in loop 2300 claim note as:
- For professional and dental claims, segment NTE01 must contain 'ADD' and segment NTE02 must contain the note, for example: NTE*ADD*CORRECTED PROCEDURE CODE
- For institutional claims, segment NTE01 must contain 'UPI' and segment NTE02 must contain the note, for example: NTE*UPI*CORRECTED LAB CHARGES
Secondary claims via EDI
When sending us a secondary claim, please include the following required information:
- Primary payer name
- Primary payer member ID for the patient
- Primary payer allowed amount
- Primary payer payment amount
- Primary payer reason for nonpayment (i.e., non-covered service, deductible, benefit maximum)
- Primary payer adjudication date for claim is required
If you have questions about billing these from your system, please contact your system vendor or clearinghouse.
Medicare note: When Premera is secondary to Medicare, there's no need to submit claims to Premera if your Medicare explanation of payment indicates the claim was forwarded (or crossed over) to the secondary payer. Submitting the claim to us will cause a duplicate.