Requirements for Filing an Adjustment
An adjustment request is processed as a replacement to the original,
incorrectly paid claim. The original payment for the claim is completely
deducted. All claim items on the request must be correctly completed. An
adjustment must be for the entire amount, not just for remaining unpaid
amounts or units.
A legible photocopy of the original claim or an entirely new claim can be used when
submitting an adjustment.
The provider does not need to send an adjustment request for each claim
line that paid incorrectly. All errors can be corrected with one
adjustment request.
Adjustments must be received by the Medicaid fiscal agent within one year
of the date of payment.
Partially Incorrect Claim Lines on a Claim Form
Use the following procedures when some claim lines on a claim form
paid correctly and other lines did not pay correctly.
If some claim lines paid correctly and some lines denied, do not request
an adjustment. Cross out the claim lines that were paid, change the total
amount billed, correct the errors on the lines that denied, and resubmit
the claim. If all the claim lines paid, but some paid incorrectly, request
an adjustment.
Make needed corrections and circle the items to be corrected in black ink.
Do not cross out the lines that paid correctly. Crossed-out lines are
treated as voids and payment for these lines will be recouped.
If one claim line needs to be deleted from a claim that has other lines that
paid correctly, request an adjustment not a void. If the request is marked
as a void, all the claim lines will be recouped. To delete one line, mark
the request an adjustment, circle the line to be deleted, and write “delete”
to the side of the line.
Adjustment Instructions
When requesting an adjustment or void, the provider must:
· Resubmit a photocopy of the original claim or a new claim form;
· Enter the items listed below;
· Ensure that the items on the adjusted claim match the items on the
original
claim, except for the corrections that are made and circled in black ink;
· Initial and date the form if it is a photocopy, or sign and date it if
it is a new
form;
· Attach copies of the documents that were required for the original
claim to
the adjustment request; and
· Mail the adjustment or void request to the fiscal agent for processing
to:
Adjustments and Voids
P.O. Box 7080
Tallahassee, Florida 32314-7080
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