Rebill, Update or Correct Claims

Most denied claims and service lines can be rebilled as a new claim or updated/corrected as long as the claim is submitted in a timely manner.

Rebill claims

Rebill when HPSM denies a claim because of incorrect information supplied on the claim form. In such cases you can rebill these claims by submitting a new claim form that has fixed the issue that triggered the denial. For example, you can rebill for claims that HPSM denied because of:

  • Lack of required information (e.g., NDC, primary insurance information, rendering NPI, modifiers, medical records/invoice and HIPPS codes)
  • Invalid data (e.g., ICD-10 codes or sets, invalid modifier for the service/item)

How to rebill claims

You can rebill HPSM using the same method used to submit claims. Please submit denials requesting additional documentation on paper and address to:

Health Plan of San Mateo
Attn: Claims Processing
801 Gateway Blvd., Suite 100
South San Francisco, CA 94080

Submission timeframes

  • Medi-Cal: Rebill within 6 months of service date
  • CareAdvantage, Healthy Kids and HealthWorx: Within 12 months of service date

Update or correct claims

Update or correct claims when you want to change a claim that has already been processed. For example, you can correct or update claims or claim lines when you want to:

  • Make changes to paid service lines
  • Report overpayments (including retro application of share of cost deductions)
  • Request reimbursement for a claim or service line that was originally denied as a duplicate

How to correct or update claims

  1. Fill out the Claims Correction Request Form completely: be sure to include all the required information
  2. Attach a copy of the corrected CMS-1500 or UB-04 form
  3. Submit the form to HPSM by fax or mail:

Fax: 650-829-2051

Mail: Health Plan of San Mateo
Attn: Claim Corrections
801 Gateway Blvd., Suite 100
South San Francisco, CA 94080

Additional information

  • Be sure to only submit corrections or updates after receiving the final disposition of the claim in question
  • Providers are encouraged to use the rebill process noted above when possible as this will expedite reimbursement
  • To check the status of a claim call 650-616-2106 or email claimsinquiries@hpsm.org
  • To submit a formal appeal or dispute use the standard appeals process, not the Claim Correction Request form