Box 22. - RESUBMISSION CODE / ORIGINAL REF. NO.

INSTRUCTIONS: List the original reference number for resubmitted claims. Please refer to the most current instructions from the public or private payer regarding the use of this field (e.g., code).

Note - When resubmitting a claim, enter the appropriate bill frequency code left justified in the left-hand side of the field (11 characters max). 7 Replacement of prior claim
8 Void/cancel of prior claim The reference number assigned by the destination payer or receiver to indicate a previously submitted claim or encounter (18 characters max).

(This Item Number is not intended for use for original claim submissions).

Note - This box is not used by Medicare

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Right click on and edit the bill. Click on the UB-04 / CMS extras button. (Box 22 'Medicaid Resubmission Code' works in all states, all sources of payment, 10 digits max. Also works in PrtCap)(No split to the Resubmission Code box & Original REF. No.).

9/14/14 through 4/29/2019. Corrected claims - Enter a 7 and seven spaces, then up to 10 digits for the original ICN#. Void claims - Enter an 8 and seven spaces, then up to 10 digits for original ICN# (That's 18 digits maximum all total)(Works in PrtCap also)(If need more than 10 digits for original ICN#, try using less spaces; one for each extra digit needed).(HINT!!! Hint!!! HINT!!! - one digit for code (7 or 8) plus the number of digits in the ICN# subtracted from 18 = the number of spaces you need).

Note: If doing PrtCap they may want to check with their clearing house to make sure this is what they want for corrected claims. Could want a box 19 entry or something else.

Note: This does NOT work for ANSI. See Replacement-Void Claims for all types of Replacement/Void claims.

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4/30/2019 & Above:

Right click on the bill and click on Edit/Apply Credits to Selected Bill.
Click the UB-04 / CMS Extras button

Field 22 (Reference) - Enter the Original Reference # here (up to 18 characters)
Field 22 (Code) - Enter the Resubmission Code here (up to 11 charaters)