SPOT Quick Steps - Claim corrections

Quick Steps

1. Access SPOT's claim correction feature from the appeals submenu.
2. Find the claim by entering the required fields in the search tab and click search.
3. Click the claim summary icon under the actions column. The claim summary icon is only active on a claim that is eligible to be reopened. See limitations listed below.
4. Enter the beneficiary's first and last name and click submit.
5. Click yes to resubmit the entire claim for a history correction with no changes or click no to edit details on the claim for correction.
6. Complete the claim corrections needed. Data fields will only open when information is eligible to be edited. Only service lines that have a pencil icon can be corrected.  If the pencil icon is not visible for a particular line of service, that line is not eligible for correction.
   1. If header edits are needed, click the Edit button. Once edits are complete, click Submit. If line edits are not needed, click the second Submit button at the bottom of the page.
   2. If line edits are needed, click the pencil icon to make corrections to a particular line. Once edits are complete, click save and then click submit. 

Changes that can be made

Below is a list of actions that can be made using the Claim Correction feature:

• Change the referring provider name and national provider identifier (NPI)
• Change the number of services or units
• Add or change the claim diagnosis codes
• Add, change, or delete eligible modifiers
• Change the procedure code
• Change the date of service
• Change the place of service
• Change the billed amount

Claim correction limitations

Below is a list of limitations with the Claim Correction feature:

• Line items may not be added or removed
• Requests may not be submitted later than one year from the receipt of the initial determination
• Rendering provider's NPI may not be changed
• Services requiring the review of medical documentation
• Services with limitation of liability
• Services involving Medicare as a secondary payer
• Only assigned claims can be reopened through the claim correction feature
• Refer to the Restricted codes for claim reopenings web page for the lists of codes that cannot be corrected through SPOT

For any claims that cannot be corrected through the claim correction feature, please utilize the Appeal Requests feature to submit your appeal. This option will allow you to upload any documents you may need to support your request. Instructions can be located in the SPOT User Guide: Section 6.