For CMS-1500 (Professional) Claims, use our online claim form and select "Corrected Claim."
- For CMS-1500s, write (or stamp) "CORRECTED CLAIM" on the claim form.
- For UB-04 (Institutional) claims, insert a "7" as the third digit in the Bill Type Code (Box 4) to indicate that the claim is corrected.
- Re-submit to the Midlands Choice claim mailing address--P.O. Box 5809, Troy, MI, 48007-5809
- On CMS-1500 (837P) and UB-04 (837I), populate replacement claim in Loop 2300, Segment CLM05-3, with a "7" for "replacement to a prior claim."
- Re-submit to your clearinghouse.