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Replacement Claims

Replacement Claims

Replacement Claims – NC Medicaid & Other Payers

Use this guide to verify the ICN/DCN, create a replacement claim batch, and confirm the 837 output.

Replacement claims are used when a paid claim was transmitted with missing or incorrect information (e.g., missing visits, wrong hours).
Do NOT use a replacement if the claim rejected and did not pay. In that case, just rebuild and resend a new claim.
Each NC Medicaid claim has a 15-digit ICN (Internal Control Number) that uniquely identifies one payment of one claim.
The same steps can be used for other payers (Medicare, HMOs, BCBS, etc.), but the ICN/DCN/Claim Number format and name may differ.

Overview

Step 1 – Verify or enter the correct ICN/DCN/Claim Number.
Step 2 – Create the replacement claim batch with matching dates and chart information.
Step 3 – Confirm replacement indicators in the 837 file and on the printed claim (UB-04 or CMS-1500).

Step 1 – Verify ICN / Claim Number

First, confirm the ICN/DCN/Claim Number in Accounts Receivable > ICN Edit. This information is automatically added when the electronic remittance advice is posted using Barnestorm.

Go to Accounts Receivable > ICN Edit.
Enter the patient’s Chart Number.
If the patient has multiple payers, select the correct Payer.
Review the ICN list on the right, including:
- From Date, Through Date
- Paid Date
- ICN (claim number)
Identify which ICN needs to be replaced based on the service dates and payment; note the From and Through dates.
If the dates you need to replace are not listed, or the ICN is missing, add it manually (see below).

If the ICN you need is not listed

Click Add a New ICN Entry.
From your paper/electronic remittance, enter:
- Payment Date
- Claim From Date
- Claim Through Date
- ICN / DCN / Claim Number
Click Save.
Confirm your new ICN now appears in the list and note the From and Through dates for the next step.

Step 2 – Create the Replacement Claim Batch

Batch Rule:A replacement batch can only generate if every claim in the batch has a valid ICN in the system and there is no existing filename for that batch.

Go to Billing > All Other Billing.
Enter the From and Through dates exactly as they appeared on the original claim you are replacing.
- The system searches for the ICN using: Chart#, Program, Payer, and the first visit date.
- If you changed the first visit date while correcting the claim, you may need to update From Date to the new first-visit date.
Enter the patient’s Chart Number.
Select Prepare Charges For Billing.
Check the box Send as Replacement Claims.
Important: This step is required for the claim to be marked as a replacement.
Click Create HIPAA Tx to generate the 837 file.
Return to Accounts Receivable > ICN Edit and confirm:
- The Batch Number now appears beside the ICN for the claim you just created.
Transmit the batch to Medicaid (or the appropriate payer) as you normally would.
The transmission process is the same for replacement and original claims.

Step 3 – Advanced: Confirm in 837 & on Claim Forms

Once the transmission is created, you can open the 837 file in your claims folder and verify the replacement indicators.

UB-04 (Institutional) – 837 Details

Find the line that begins with CLM*. After the :: you will see a number:
- 1 = Original claim
- 7 = Replacement claim (if there is no “7”, it is not a replacement)
- 8 = Void claim
The line immediately after the CLM* line contains the ICN.
On the printed UB-04 claim form, the Type of Bill (TOB) will show 0327 (top-right corner) for a replacement.

CMS-1500 (Professional) – 837 Details

As with UB-04, check the CLM* line:
- 1 = Original claim
- 7 = Replacement claim (if there is no “7”, it is not a replacement)
- 8 = Void claim
For replacement claims, you will see an additional line after the CLM* line, similar to:
REF*F8*1234567890
This 1234567890 represents the ICN.
On the printed CMS-1500, the 7 (or 8 for void) and the ICN will appear on the same line or beneath the ICD codes.