12/21/2016

A claim cannot be processed as a "corrected" claim unless it is resubmitted with an indicator to alert our processing system that the claim is a replacement claim. Please follow the guidelines below to assure that corrected claims are not rejected as duplicates.

  • When using the Midlands Choice.com online claim form for CMS-1500 (Professional) claims, select the "Corrected Claim" box at the top of the form.
  • When submitting paper claims:
    • For CMS-1500 claims, 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.
    • Resubmit to the Midlands Choice mailing address - PO Box 5809, Troy, MI 48007-5809 or the claim address on the patient's member ID card.
  • When submitting claims electronically:
    • For both Professional (837P) and Institutional (837I) claims, populate replacement claim in Loop 2300, Segment CLM05-3 with a "7" for "replacement to a prior claim".
    • Resubmit to your clearinghouse.