Resubmission code 7 indicates a corrected or replacement medical claim. In 2025, accuracy in using this code is essential due to updated payer rules and CMS guidance. This article explains when and how to use resubmission code 7, changes you need to know in 2025, and practical tips to avoid claim denials.
What Is Resubmission Code 7?
Resubmission code 7 is a claim frequency code used to indicate a corrected or replacement claim. This tells the payer that the new claim updates or fixes an earlier one. On the CMS-1500 form, code 7 is entered in Item 22 along with the original claim reference number. In electronic claims (837P), it’s reported using Claim Frequency Type Code “7” and the original claim number is included in the REF segment.
When Should You Use Resubmission Code 7?
Use code 7 only when:
- You submitted a claim with errors (wrong CPT, diagnosis code, modifier, etc.).
- A claim was processed incorrectly due to missing or inaccurate data.
- You need to add or correct information after claim processing.
For example, if a claim was denied due to a missing modifier or submitted under the wrong patient, code 7 allows you to resubmit it with corrections.
Important: Don’t use code 7 to follow up on a claim that hasn’t been processed or to appeal a denial based on coverage. For appeals, follow your payer’s formal dispute process.
Resubmission Code 7 vs. Code 8
Understanding the difference between resubmission codes is crucial:
- Code 7 = Corrected or replacement claim.
- Code 8 = Void or cancel a previously submitted claim.
Use code 8 only when you need to remove a claim completely—such as when it was submitted in error or duplicated. Mixing these up can result in recoupments or payment delays.
Steps to Submit a Corrected Claim with Code 7
- Enter Code 7 in Box 22: Type “7” in the left side of Item 22 on the CMS-1500.
- Provide the Original Claim Number: Include the payer’s reference number from the EOB or payer portal.
- Include All Line Items: List all services from the original claim—even those not corrected—to avoid partial recoupments.
- Mark “Corrected Claim” Clearly: If required, label paper claims or follow payer-specific rules for corrections.
- Attach Supporting Docs If Needed: Include medical records, EOBs, or other required documents for the correction.
- Submit Electronically: Most payers accept code 7 via EDI. Use the correct claim frequency code and original claim reference segment.
- Follow Up: Check remittance advice and payer portals to ensure the corrected claim is accepted and processed.
2025 Payer Updates for Resubmission Code 7
- Medicare: Generally does not accept code 7 for corrections. Use the reopening or redetermination process.
- Medicare Advantage: Many accept code 7 via EDI, but confirm each plan’s process.
- Commercial Insurers: UnitedHealthcare, Anthem, and others support code 7 for corrected claims. Ensure all data is complete and accurate.
- State Medicaid Programs: Most accept code 7, but some require additional indicators like an “A” in Box 22 or specific forms.
Best Practices for Corrected Claims
- Always use the correct original claim number.
- Resubmit all claim lines—not just corrected ones.
- Use the correct claim frequency code and claim type in your billing software.
- Confirm payer-specific rules, especially for Medicare and Medicaid.
- Submit corrections promptly and track outcomes via EOB or payer portal.
FAQs About Resubmission Code 7
What’s the difference between code 7 and 8?
Code 7 is used for corrected or replacement claims. Code 8 is used to void a previously submitted claim entirely.
Can I use code 7 for Medicare claims?
No. Medicare Part B does not allow code 7 corrections. Use the reopening or appeal process instead. However, Medicare Advantage plans may accept it—check plan-specific policies.
How long do I have to submit a corrected claim?
Timely filing limits vary. Many payers require corrections within 90–180 days of the original submission. Medicare typically allows 12 months.
Conclusion
Using resubmission code 7 correctly ensures that your corrected claims are processed without delay. As payer rules evolve in 2025, staying compliant with each insurer’s expectations—especially Medicare vs. commercial plans—can make or break your revenue cycle performance. Be precise, timely, and consistent when submitting corrected claims, and you’ll avoid costly denials or delays.
Learn more about Box 22 Resubmission Codes