Learning Resources
Frequently Asked Questions
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ADJUSTMENTS |
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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. | |