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. To bypass the Accidentally marked as failed to process? option, refresh your browser page and the Re-submit edi file button will appear.

Resubmit the claim by clicking the Re-submit edi file button.

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 insurance 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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