EDI 117 Institutional Claim Replacement Workflow
An interactive guide to submitting a Type of Bill (TOB) 117 to replace or correct a previously adjudicated institutional claim (EDI 837I).
Key Identifier Rules for a Replacement Claim
New Patient Control #
Assign a new, unique Patient Control Number (PCN) in the `CLM01` segment. This prevents the claim from being rejected as a duplicate.
Frequency Code '7'
Set the Claim Frequency Code in the `CLM05-3` segment to **'7'**. This explicitly tells the payer's system this is a replacement claim.
Original Payer ICN/DCN
Include the original claim's Payer Claim Control Number in the `REF02` segment with an **'F8' qualifier** in `REF01`. This links the replacement to the original.
✨ Correction Strategy Assistant
Enter a description of your claim error or denial code. The assistant will provide a 3-step strategy to determine if you need to file a **117 Replacement**, a **118 Void**, or a **new 111 Original** claim.