Correcting Claims in Availity

After you’ve processed claims through Aloha to get sent to Availity, you may encounter a situation where you need to fix or correct a claim. Before we get started, let’s define these words:  

Rejection: When a claim is rejected, the claim must be fixed so that it goes through to the payer. A rejected claim means that it got stuck in the clearinghouse (Availity) due to a clerical or demographic error, and has to be addressed before the payer receives it.  Sometimes a claim is accepted by the clearinghouse and then rejected by the payer before a claim number is created for it.  This should still be treated as a rejection rather than a denial..

Denial: When a claim is denied, needs to be edited after submitting and has been received already, or voided, then it needs to be corrected. A denied claim has been received by the payer and denied for whatever reason, and needs to be addressed before resubmitting for reconsideration.

Claim Correction due to a Mistake:  If you realize you made a mistake on a claim that wasn't denied or rejected by the payer, it's still important to do a claim correction.

Claim Fixes in Availity

Rejection

There is no way to do correct a claim in Availity for a rejection.  Please view the information for Claim Fix in Aloha

Denials (or if you realize you made an error):  

You can recreate a claim, and submit it as a replacement or cancellation (void) of the original claim, if the payer has already accepted the original claim for processing. Follow these steps:

1.  In the Availity Essentials navigation bar, select Claims & Payments > Claims & Encounters

2.  Begin filling in your organization information.  Click either Professional Claim, Facility Claim, or Dental Claim under Claims, depending on which type of claim you want to correct.  Typically behavior analytic claims are considered Professional Claims.  Then fill in the patient information.  

      

3.  Enter the claim information.  See HIPAA compliant sample below:

Set the billing frequency to either Replacement of Prior Claim or Void/Cancel of Prior Claim in the Claim Information section (for professional and facility claims).  You will use Replacement of Prior Claim if the claim has been processed and Void/Cancel of Prior Claim if the claim is still in processing.

Set the Payer Control Number (ICN / DCN) (or Payer Claim Control Number) field to the claim number assigned to the claim by the payer. You can obtain this number from the 835, if available.

4.  Submit the claim.

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