Medical billers and coders frequently encounter the term original ref no on claim to Medicaid I when resubmitting or correcting claims. In this 2025 update, you’ll understand how to correctly include that original reference number on both electronic and paper claims, comply with timely‑filing rules, and reduce denials.
Overview of 2025 Medicaid Guidelines
In 2025, Medicaid payers and CMS emphasize accuracy when submitting corrected or voided claims. Updated rules require including the exact original claim reference number—often called the Transaction Control Number (TCN) or payer claim control number—in both paper and EDI submissions :contentReference[oaicite:0]{index=0}.
Additionally, effective June 2, 2025, some Medicaid plans (e.g. managed care) began strictly rejecting any corrections to $0‑allowed original claims unless submitted as a “corrected claim” with frequency code 7 :contentReference[oaicite:1]{index=1}.
What Is the “Original Ref No on Claim to Medicaid I”?
This represents the unique identifier assigned by Medicaid (or the fiscal agent)—the payer claim control number—that reflects the original claim. In electronic 837 submissions, it’s placed in loop 2300, REF01=F8 and REF02=[original number]. In paper CMS‑1500 claims, it is entered in item 22 alongside a resubmission code :contentReference[oaicite:2]{index=2}.
When to Use It: Resubmissions, Corrections and Voids
Corrected/Replaced Claims (Frequency Code 7)
Use frequency code 7 when replacing a prior claim. Always include the original ref number, exactly as reported in your remittance advice. Plans now reject “new” submissions where $0 was allowed if the original ref number is omitted or invalid :contentReference[oaicite:3]{index=3}.
Voiding a Claim (Frequency Code 8)
Use frequency code 8 to cancel an entire previously paid claim. Include the original reference number just as with corrected claims. Note: voids are used only if the member or provider ID changed; otherwise use code 7 :contentReference[oaicite:4]{index=4}.
Filing Format: Electronic vs Paper
Electronic (837P / 837I)
- In Loop 2300, enter CLM05‑3 = “7” or “8” to indicate replacement or void.
- Include REF01 = “F8” and REF02 = the original claim number (no dashes/spaces).
- Submit the full episode of care—partial resubmission may cause credit balances.
This applies across states and plans including Iowa Medicaid, Amerigroup, others :contentReference[oaicite:5]{index=5}.
Paper CMS‑1500 (Professional Claims)
- In Box 22: left side = frequency code (“7” or “8”), right side = original claim number.
- Use the payer-assigned reference (often TCN from remittance) exactly.
- Only use Box 22 for resubmissions—not for initial claim.
Paper claims without the correct original reference number are often delayed or denied :contentReference[oaicite:6]{index=6}.
Timely Filing Limits & Exceptions in 2025
Many state Medicaid programs allow adjusted claim resubmissions within defined windows. For example:
- New York Medicaid: replacement/voids must be filed within 60 days from notification if original claim was paid or denied—but not for timely filing edits :contentReference[oaicite:7]{index=7}.
- Pennsylvania AmeriHealth Caritas: denied claims must be re‑submitted as corrected claims within 365 days of service date :contentReference[oaicite:8]{index=8}.
- NC Medicaid: initial claims (not adjustments) must arrive within 365 days of service date :contentReference[oaicite:9]{index=9}.
Always check your payer’s official policy. Late resubmissions without acceptable delay codes risk denial.
Practical Tips to Avoid Rejection
- Verify the original reference number from the remittance advice before resubmission.
- Never strip dashes or spaces if payer requires exact formatting—but many systems prefer no separators.
- Match member ID and provider taxonomy/NPI; if these change, void the original claim rather than correct it :contentReference[oaicite:10]{index=10}.
- Submit entire episode of care when using frequency code 7.
- Track payer-specific deadlines and follow state manuals for delay reason codes if filing late.
FAQ
What if the original claim number is missing or lost?
If the original TCN or reference number is unavailable, contact the payer or refer to the remittance advice system. You cannot submit a correction without this. Claims missing the number are likely to be rejected.
What if the original claim was denied quickly (rejected vs denied)?
Rejected claims (missing data) are considered new and should be submitted as original. Denied claims (processed then denied) must be resubmitted as corrected claims with frequency code 7 and include the original reference number.
Conclusion
Understanding and correctly using the original ref no on claim to Medicaid I is essential in 2025. By including the exact payer-assigned reference number and proper frequency code, you reduce errors, fulfill timely filing requirements, and improve claim accuracy.
Therefore, verify remittance control numbers, follow state-specific deadline rules, and always include the original reference number on corrected or voided claims. For deeper guidance, check your payer’s provider manual or consult authoritative sources like CMS 2025 guidelines, AHIMA.org, or AAPC.com.
For more articles on related billing topics, visit:
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