Original, Corrected, Replacement & Void Claims

Submitting a medical claim is not always a one-time process. A provider may discover that information on a previously submitted claim needs to be corrected, a payer may require a prior claim to be replaced, or a claim may need to be voided entirely.

Terms such as original claim, corrected claim, replacement claim, resubmission and void claim describe different situations. Understanding what happened to the previous claim is important before deciding what should be submitted next.

This guide provides an overview of the most common claim submission types, including Claim Frequency Type Codes 1 (Original), 7 (Replacement) and 8 (Void/Cancel), and explains how corrected, replacement and void claims relate to one another.

Understanding the Medical Claim Lifecycle

An original claim begins the claim lifecycle, but what happens afterward depends on how the payer receives and processes the submission.

The correct next action depends on the status of the prior submission. For example, correcting a claim that was rejected before adjudication may be different from replacing a claim the payer has already processed.

What Is an Original Medical Claim?

An original claim is the initial submission of a claim to the payer. It represents the provider's first request for the payer to process the reported healthcare services.

An original claim should generally contain the information necessary for the payer to identify the patient or subscriber, provider, services, diagnoses, dates and charges associated with the claim.

For an electronic professional claim, the claim frequency information is transmitted as part of the 837P Claim Information. For a paper professional claim, resubmission information is associated with HCFA-1500 Box 22.

Note: Box 22 is generally not populated for an original claim unless specifically instructed by the payer.

What Is a Corrected Medical Claim?

A corrected claim is a commonly used term for a claim submitted to correct information from an earlier claim. The correction could involve information at the claim level or service-line level, depending on what needs to be changed and what the payer permits.

Examples of information that might require correction can include:

• patient or insured information;
• provider information;
• dates or details related to reported services;
• diagnosis information;
• charges, units or other service-line information; or
• other claim information that was reported incorrectly.

The term corrected claim is often used operationally, while replacement claim more specifically describes the submission used to replace a prior claim. We will explore that distinction in greater detail in a supporting article in this series.

What Is a Replacement Claim?

A replacement claim is submitted when a previously submitted claim needs to be replaced with updated or corrected information. Rather than simply submitting another unrelated original claim, the replacement identifies that it is associated with a prior claim.

A replacement claim generally includes both the corrected claim information and a reference that allows the payer to associate the new submission with the prior claim.

For professional claims reported on the HCFA-1500/CMS-1500 form, this relationship is commonly reported through Box 22, which can contain the resubmission code and the payer's original claim reference number.

What Is a Void Claim?

A void claim, sometimes referred to as a void or cancel request, is used when the intent is to cancel a prior claim rather than replace it with corrected information.

The intent of a void is fundamentally different from a replacement. A replacement tells the payer that a prior claim should be replaced by the newly submitted claim information. A void tells the payer that the prior claim should be canceled.

As with a replacement claim, the payer generally needs enough information to identify the prior claim being referenced. Exact submission requirements should always be verified with the payer.

Original vs. Replacement vs. Void Claims

The three Claim Frequency Type Codes most commonly encountered when discussing original, replacement and void professional claims can be summarized as follows:

Note: These descriptions provide a general overview. Payer-specific requirements can vary, including when a replacement or void is accepted and what prior claim information must accompany the submission.

Is a Corrected Claim the Same as a Replacement Claim?

The terms are closely related, but they describe the situation from slightly different perspectives.

A corrected claim generally describes the reason for the new submission: something about the previous claim needs to be corrected. A replacement claim describes how the new claim is being submitted in relation to the prior claim: the new submission is intended to replace it.

In everyday billing workflows, a replacement claim may therefore be referred to as a corrected claim. However, the terminology and submission process used by a specific payer should always be reviewed before resubmitting the claim.

What Information Is Needed for a Replacement or Void Claim?

A payer must be able to determine which prior claim the replacement or void submission is referencing. This commonly involves two important pieces of information:

• Claim Frequency Type Code – identifies whether the submission is an original, replacement or void claim.
• Original Reference Number / Payer Claim Control Number – identifies the prior claim within the payer's system.

For HCFA-1500/CMS-1500 professional claims, these items are associated with Box 22 - Resubmission Code and Original Reference Number.

For a detailed explanation of Box 22 and its electronic 837P mappings, see our HCFA-1500 Box 22 - Resubmission Code and Original Reference Number guide.

Rejected and Denied Claims Are Different

Before deciding to submit a corrected or replacement claim, it is important to understand whether the original submission was rejected or denied.

A rejected claim generally did not successfully enter or complete the payer's claim adjudication process because the submission could not be accepted or processed as submitted. A denied claim, by comparison, has generally been accepted and adjudicated but was not approved for payment in whole or in part.

This distinction matters because submitting Claim Frequency Type Code 7 is not automatically the correct response to every rejection or denial.

Should You Resubmit, Replace, Void or Appeal a Claim?

The status of the previous claim and the reason action is needed should guide the next step. The following table provides a general framework:

Frequently Asked Questions

Important: Claim correction, replacement, void and appeal procedures can vary by payer and program. The information in this guide provides a general overview and should be used together with the payer's current billing and submission requirements.

For technical requirements related to electronic claim submissions using the X12 837 transaction, refer to the official implementation guides published by X12.