111 Rebill

The process of re-billing a hospital patient from Type of Bill (TOB) 111 to TOB 117 is essentially submitting a corrected or replacement claim for an initial inpatient stay.

In medical billing, the Type of Bill (TOB) is a four-digit code (often represented by the last three digits) used on the UB-04 claim form to tell the payer (like Medicare or a commercial insurer) three things:
  • The type of facility.
  • The type of care/classification.
  • The frequency of the bill.
Here is a breakdown of the codes and the process:

1. Understanding the Type of Bill Codes

Code
Facility
Classification
Frequency
Meaning
111
Hospital
Inpatient
Admit through Discharge
This is the original, final claim for an inpatient stay from admission to discharge.
117
Hospital
Inpatient
Replacement of Prior Claim
This is a corrected claim used to replace or adjust a previously submitted claim (like the 111).

2. The Re-billing Process (111 to 117)

The need to re-bill usually arises when an error is found on the original TOB 111 claim after it has been accepted by the payer, or sometimes if the payer denies it for a correctable reason.
The general steps for a hospital to re-bill an inpatient claim from 111 to 117 are:
  1. Identify the Error: The billing department determines the mistake on the original TOB 111 claim. Common errors include wrong diagnostic codes, incorrect dates of service, or improper patient discharge status.
  2. Use TOB 117: A new claim is created, using Type of Bill 117 to signal that this claim is a replacement of a previous one.
  3. Reference the Original Claim: The most critical step is to include the Document Control Number (DCN) or Claim Number of the original TOB 111 claim. This tells the payer exactly which claim to void/cancel and replace with the new information.
  4. Make Corrections: The necessary changes (e.g., corrected diagnosis, updated procedure codes, revised discharge status) are made to the rest of the UB-04 form. The statement covers period (From/Through dates) typically remains the same as the original stay.
  5. Submit the Corrected Claim: The TOB 117 claim is submitted to the payer. The payer is then instructed to cancel the previous TOB 111 claim and reprocess the new TOB 117 claim with the corrected data.
The TOB 117 is the mechanism used to officially adjust or replace an already processed claim to ensure payment accuracy, rather than simply sending an appeal.
Where do you reference the DCN in the 117?
The Document Control Number (DCN) of the original claim is referenced on the UB-04 form in Form Locator (FL) 3.
When a hospital re-bills a claim from Type of Bill (TOB) 111 to 117 (a corrected/replacement claim), the following applies to Form Locator 3:
  • Form Locator 3 is titled “Patient Control No.” on the UB-04.
  • The first line of this field, which is often used for the internal Patient Control Number, is also used to enter the Document Control Number (DCN) or Claim Number of the original bill (the TOB 111) that is being corrected.
  • This DCN acts as a pointer, instructing the payer’s system to cancel/void the original claim and replace it with the new TOB 117 claim.
This is a critical step for a TOB 117 claim to be processed correctly as a replacement, otherwise, the payer might treat it as a duplicate or a new original claim.
What happens if the payer treats a 117 as a new claim?
If the payer treats a Type of Bill (TOB) 117 (Replacement/Corrected Claim) as a new, original claim (like a TOB 111), it typically results in a duplicate billing denial.
Here is what happens in that scenario:
  1. Duplicate Claim Denial: The payer’s system sees the same patient, the same dates of service, and similar charges as the original TOB 111 claim, but without the necessary reference to the original DCN to indicate it’s a correction. The system flags it as a duplicate and denies it.
  2. No Voiding of Original: The payer does not void or cancel the original TOB 111 claim. This means the original, potentially incorrect payment and claim details remain on file, which can lead to inaccurate reimbursement and patient account balances.
  3. Required Corrective Action: The hospital’s billing department must then re-submit the claim, ensuring:
    • The Type of Bill is correctly 117.
    • The Document Control Number (DCN)of the original claim is accurately placed in Form Locator (FL) 3(Patient Control No.).
This correct submission (117 with DCN) is essential for the payer’s system to understand that it needs to cancel/reversethe first claim and reprocessthe second one.

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