To fill box 22 of the CMS 1500 claim form: Resubmission Code/Original Reference number, first select "Ask for resubmission details prior to Re-Submit failed claim" in the EDI file settings of the Insurer Details page (Billing > Insurers).

  1. Click Billing > Submitted Claims


 2. Mark the claim as failed to process by clicking Mark As > Failed to Process.

3. Correct the error in the client's profile or invoice and save the page where the update is being made.

4. Resubmit the claim under the Billing > Submitted Claims page by clicking Re-submit edi file.

5. If you enabled, "Ask for resubmission details prior to Re-Submit failed claim" in the EDI file settings to populate box 22 of the claim form, enter the required resubmission details:

Resubmission Code
Original Reference Number (you may need to call the payer to get the Original Reference Number).

6. Click Re-Submit.

Resubmission details appear in Loop 2300 of the EDI file and Box 22 of form CMS1500:

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