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Medicaid Provider Enrollment Portal - Resubmission of Previously Denied Claims

Date: 01/18/23

On January 5, 2023, Healthy Louisiana revised Informational Bulletin 22-38: "Medicaid Provider Enrollment Portal Update and Requirements.” This notice is to address the specific revision regarding resubmission on previously denied claims below:

Per IB 22-38 “Once the enrollment is completed, the provider may resubmit previously denied claims for dates of service between January 1, 2023, and June 30, 2023, for processing. Providers will not receive payment until their provider enrollment is complete.”

Given the option that providers may resubmit any previously denied claims once enrolled, Louisiana Healthcare Connections would like to remind you of the billing guidelines and requirements involving replacement or void/cancellation requests of a prior claim.

Submitting Replacement and Void/Cancelled Claims:

1500 HCFA Form Type: Replacement and Void/Cancel of Prior claims is identified by the resubmission code and original reference number in Field 22.

  • List the original reference number for resubmitted claims in the right-hand side of the field. Please refer to the most current instructions for use of this field.
  • When resubmitting a claim, enter the appropriate bill frequency code in the left-hand side of the field
    • 7 – Replacement of prior claim
    • 8 – Void/cancel of prior claim

1450 UB Form Type:  Replacement and Void/Cancel of Prior claims is identified by type of bill in Field 4.

  • 0XX7 Replacement of Prior Claim
    • This TOB code is used when a specific claim needs to be restated in its entirety, except for the identifying information.
    • The original bill is considered null and void, and the information on this bill completely replaces the previous claim.
  • 0XX8 Void/Cancel of a Prior Claim
    • This code indicates that this claim eliminates and cancels a previously submitted claim.
    • Use this code to indicate that this bill is an exact duplicate of an incorrect bill, previously submitted. A code 0XX7 claim must be submitted to show the corrected information.

Where can I find more details?

Billing Instructions, including instructions for adjustments/voids, are located also on the web site directory link, Billing Information.

If you have questions…

We are committed to working with impacted providers to resolve any concerns with these requirements. Please contact Provider Services at 1-866-595-8133 with any questions.