Claims Adjustments/voids:
Healthcare providers and payers can request for claims
adjustment if they think that the claims got processed incorrectly.
·
Providers
will request to Payers for adjustments which are reimbursements for provider
services.
·
Payers
will request to CMS/State for adjustments which are processed part of
reimbursement
·
Payers
will also initiate adjustments if they determine that they processed a claim
incorrectly or as a part of reconciliation.
Provider request for
claims adjustment
If providers are requesting for an adjustment, they have to
provide below details:
·
Member
Name
·
Member
Id
·
Claim
Number
·
Date
Of Service
·
Reason
for adjustment
Payer request for
claims adjustment
If payers need to do claims adjustment, it involves below
steps,
·
Cancel
the original payment and create a credit balance to the provider
·
Process
the claim second time to pay the correct amount or deny the claim, whichever is
appropriate.
Few facts related to
adjusting/voiding claims:
·
Only
a paid claim can be adjusted or voided
·
Part
of adjustment, there should not be any changes to provider identification
number, recipient/patient identification number (recipient Medicaid number)
·
If it
is required to correct Medicaid number or provider number then the claim must
be voided and resubmitted correctly.
·
If a
paid claim to be voided, provider/payer must enter all the information from the
original claim exactly as it appeared on the original claim. Once a voided
claim has appeared on the remittance advice, a corrected claim can be
resubmitted.
·
An
adjustment or void will generate Credit or Debit adjustments which will appear
in the remittance summary on the remittance advice.
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