Spalon Golden

Medical billing rejections can feel like hitting a brick wall, especially when it delay payments and disrupt operations. One of the most effective tools to address a denied claim is the Resubmission Code for Corrected Claim. It signals to payers that the claim is a revised version of a previously submitted one. However, incorrect use of these codes can lead to further denials. In this article, we’ll explore what resubmission codes are, when and how to use them, and best practices to prevent common billing mistakes.

What Is a Resubmission Code?

Resubmission codes are identifiers used in claim forms to indicate why a claim is being submitted again. They help insurance companies process claims accurately without confusing them for duplicates.

There are typically four resubmission codes used on claim forms like the CMS-1500 or UB-04:

• Code 7: Replacement of a prior claim
• Code 8: Void or cancel a prior claim
• Code 5: Late charges only
• Code 6: Correction or adjustment of a previous claim

Each code has a specific purpose, but Resubmission Code 7 and Resubmission Code 8 are most commonly used for denied or incorrect claims.

Why Are Claims Denied?

Understanding why claims are denied in the first place is key to resolving them properly. Common reasons include:

• Incorrect or missing patient information
• Errors in procedure or diagnosis codes
• Duplicate billing
• Invalid provider credentials
• Services not covered under the patient’s insurance plan

A denied claim doesn’t necessarily mean payment is lost—it just means further steps, like resubmission with the correct codes, are needed.

When to Use Resubmission Codes

Using a resubmission code correctly is critical. Here’s when you should use each:

✅ Use Resubmission Code 7 (Replacement)
Use this when you’ve corrected errors in a previously submitted claim, such as:

• Updating patient information
• Fixing CPT or diagnosis code errors
• Correcting billing amounts

✅ Use Resubmission Code 8 (Void)
Use this when you need to cancel an entire claim—typically due to:

• Submission in error
• Patient ineligibility for coverage
• Duplicate claims submitted accidentally

Step-by-Step: How to Use Resubmission Codes Correctly

1. Identify the Error
   Review the Explanation of Benefits (EOB) or denial notice to understand why the claim was rejected.
2. Make the Correction
   Fix all errors in the claim, whether it’s wrong codes, misspelled patient names, or incorrect billing amounts.
3. Assign the Right Resubmission Code
   On the claim form:
   • Box 22 of CMS-1500 (Resubmission Code): Enter “7” or “8”
   • Reference Number: Add the original claim’s control/reference number
4. Submit With Documentation
   Attach the corrected claim along with a copy of the original denial or EOB, if required by the payer.
5. Track the Claim
   Follow up with the insurance company to ensure the resubmitted claim is processed.

Common Mistakes to Avoid

• Using the Wrong Code: Don’t use “7” when you should use “8.” This leads to confusion or more denials.
• Missing the Original Reference Number: Always include the claim number of the original submission.
• Ignoring Payer Guidelines: Not all payers have the same rules—always check the insurer’s resubmission requirements.
• Failing to Attach Supporting Documents: Many insurers require a copy of the EOB or correction justification.

Benefits of Using Resubmission Codes Correctly

• ⏱️ Faster Reimbursement: Correct use accelerates claim approval.
• 📉 Fewer Rejections: It signals professionalism and accuracy in medical billing.
• 📄 Clear Audit Trail: Easy tracking for compliance and reporting.
• 💸 Improved Cash Flow: Resolved denials mean more timely payments.

Understanding Resubmission Code 8
While Code 7 gets a lot of attention, Resubmission Code 8 is equally important. This code is used when a claim needs to be entirely voided. For instance, if a claim was submitted for the wrong patient or the wrong provider, Code 8 allows you to formally cancel it in the system.

Payers take resubmission codes seriously—using Code 8 when you meant to correct a claim (which should use Code 7) could mean losing out on reimbursement entirely. Therefore, accuracy matters.

Best Practices for Resubmitting Claims
🔒 Keep Detailed Records
Maintain logs of every claim submitted, denied, and resubmitted.

📞 Communicate with Payers
If you’re unclear on which code to use, don’t hesitate to contact the insurance provider.

📚 Train Your Billing Team
Regularly update your team on billing rules, payer changes, and resubmission protocols.

📆 Timely Filing
Check timely filing limits—most insurers require resubmissions within 90–180 days of denial.

Final Thoughts

Medical billing doesn’t have to be a maze of errors and delays. By using tools like the Resubmission Code for Corrected Claim and understanding how to implement Resubmission Code 8, providers and billing teams can correct mistakes quickly and secure the reimbursement they deserve. Following the right steps and keeping up with payer-specific guidelines ensures smoother claim processing and improved financial outcomes for your practice.