Correct CPT Code/Service Type for Submitted Claims

Overview

If you need to change a CPT Code on a submitted claim, you have two options. 

Option 1: Submit a Voided Claim to the Payer

Use this option to cancel the original claim before submitting a new clean claim.

1. Ensure your claim is marked Rejected/Denied.
2. From the Rejected/Denied tab, submit a voided claim (code 8 with the original claim number).
3. Wait for the payer to process the voided claim.
4. Send a new clean claim.

Option 2: Send a Corrected Claim with Updated Information

If you would like to send a corrected claim (code 7) with updated information, follow the steps below.

Step 1: Remove Client/Insurance Payments & Adjustments

If the invoice has any client or insurance payments or adjustments, the Service Type cannot be changed. All payments and adjustments must be removed first.

1. Locate the Client and open the Client Profile.
2. Click Ledger in the side menu.
3. Select the invoice you are correcting.
4. Scroll to the payments section on the invoice and click Do not apply to this invoice.
5. Next to write‑offs and adjustments, click delete.
6. Navigate to the Unapplied Payments/Credits and Refunds section of the Client Ledger.
7. Click the Delete button for the removed payments.

Step 2: Undo ERA & Claim Processing

1. Navigate to the Billing > Claims > Paid/Processed tab. 
2. Find the item you want to reverse.
3. Click Actions > Undo ERA & Claim Processing.

Step 3: Remove the Claim From All Billing Tabs & Update the CPT Code

1. If the claim is on the Accepted tab, choose Actions > Remove Claim. 
2. From the Awaiting Submission tab, choose Actions > Remove Claim.
3. Once the claim is removed from all Billing tabs, navigate to the client’s ledger and update the CPT code on the invoice.
4. Click Save.

Step 4: Add the Claim Back to the Awaiting Submission Tab

1. Turn off Production Mode (located to the far right of the screen).

   NOTE: Turning off Production Mode allows you to send a test claim that will not be sent to the clearinghouse or payer.

2. Choose Actions > Submit Claim.
3. Turn Production Mode back on.
4. Navigate to the Submitted tab, click Update Status and select Rejected/Denied.

Step 5: Resubmit the Corrected Claim

See Resubmit a Corrected Claim for detailed instructions. 

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