Saturday, October 5, 2024, 11:50 PM
Site: Healthy Connections Medicaid E-Learning
Course: Learning Resources (Learning Resources)
Glossary: Frequently Asked Questions
ADJUSTMENTS
Can you use the Web Tool for adjustments, if you filed through a clearinghouse?Yes, you may submit an adjustment through the Web Tool, even if the original claim was filed using a clearinghouse – as long as it is within 15-18 months. However, UB-04 (Institutional) billers must file adjustments in the same medium as the original claim. |
How far back can you file a void?15 - 18 months |
How long does it take to process an adjustment?It takes approximately 30-45 days to process an adjustment - the same as a normal claim in process. |
If doing a void/replace adjustment, does the Form 130 go along with the CMS-1500 claim form?Yes, the replacement claim will be attached to the Form 130. |
If you have a multiline claim and only one line needs recouping, you still complete an adjustment?Yes, claims are 100% adjusted, all lines will be replaced. |
Is an adjustment only done when you have been paid?Yes, only paid claims can receive an overpayment or underpayment. |
What happens if someone in your office initiates a refund with the 205 and an adjustment, how do you get it back?The program area would have to research the adjustment to return funds. |
What happens if you void the wrong claim?If it is voided, you can submit a new claim in. |
When a claim is in a denied status, can you do an adjustment?You must wait for the rejection, and then do a correction. An adjustment can only be made to a paid claim. |
When would you use a void?You would use a void if you bill for something by mistake; accidental claim submission, for example. |