Edit 690
Edit 690
Issue: Other Sources Amount More than Medicaid Amount
Verify and correct the dollar amounts entered in the insurance
payment field(s) below. If the amounts are correct, no payment is due
from Medicaid. Do not submit a new claim.
CMS-1500 CLAIM: Insurance amount paid (fields 9C and 11B),
amount rec’d insurance (field 29)
Last modified: Wednesday, December 6, 2017, 4:18 PM