Thursday, August 22, 2019, 10:38 AM
Site: Healthy Connections Medicaid E-Learning
Course: Learning Resources (Learning Resources)
Glossary: Frequently Asked Questions

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.