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Coming Soon! New Denial Reason Code for Duplicate Corrected Claims
1/13/2023 • Posted by Provider Relations

Fidelis Care would like to inform our providers that a new claim denial reason code is in process for duplicate claim resubmission submitted on the same day.

EX CODE:  5V

Description:  Exceeded daily submission limit (or frequency) for this claim

Fidelis Care will process the first corrected claim received.  Any duplicate submissions of the claim on the same day will reject through the Electronic Data Interchange (EDI) system with the code ‘5V’.  This claim denial will not show on the remittance.

Providers will continue to see denial reason code ‘9L’ for invalid corrected claims.

 

In order to avoid denial, please follow the instructions below for claim corrections and reconsiderations:

 

Electronic Submission of Corrected COB Claims

  • The original claim number must be submitted 
  • The claim frequency type code must be a 7 (replacement of prior claim)
  • 2300 Loop, CLM Claim Information Segment, CLM05-3 Claim Frequency Type Code Element must be set to a 7 and 2300 Loop
  • REF Original Reference Number (ICN/DCN) Segment where REF01 Element equals F8, REF02 Element must contain Fidelis Care Original Claim Number
  • Only one correction for a Fidelis Care Original Claim Number should be submitted per day

 

Paper Submission of Corrected COB Claims:

  • A valid Claim form (CMS-1500 or UB-04) containing resubmission code 7 and the previous claim #

 

COB Related Reconsiderations (the claim has previously been billed to Fidelis Care, and you are requesting a reconsideration or appeal)

 

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Required Cultural Competency Training

Access the Provider Attestation Statement and submit completion of training.

Authorization Resources

To submit prior authorization request types, use the Fidelis Care provider portal.

Electronic Transactions

Submit claims electronically for faster processing and reimbursement.

Provider Access Online

Verify member eligibility or renewal status, check claims, send e-scripts, and more.

Utilization Management (UM)

Find information and links to external vendor authorization programs as well as links to internal Fidelis Care prior authorization resources.

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