Are you going to
resubmit the claim, make sure all the below points has been reviewd.
Resubmission Checklist
Use the following checklist to ensure that resubmittals are completed correctly before submitting.
* Did you wait thirty days after the original submittal before resubmitting a missing claim?
* If using a photocopy of a claim, did you make sure it was legible and properly aligned?
* If you chose to fill out a new claim, did you type or print the form in black ink? Are all multi-part copies legible?
* If you have corrected or changed the original claim form, have strike overs been corrected on each copy? (Do not use whiteout.)
* Has the resubmitted claim been signed again and dated?
Resubmission Checklist
Use the following checklist to ensure that resubmittals are completed correctly before submitting.
* Did you wait thirty days after the original submittal before resubmitting a missing claim?
* If using a photocopy of a claim, did you make sure it was legible and properly aligned?
* If you chose to fill out a new claim, did you type or print the form in black ink? Are all multi-part copies legible?
* If you have corrected or changed the original claim form, have strike overs been corrected on each copy? (Do not use whiteout.)
* Has the resubmitted claim been signed again and dated?
* Have you clipped all required attachments and documentation to the claim form?
* Is the claim clean of all highlighting and whiteout?
* Do you have the correct P.O. Box Number and corresponding nine-digit zip code for mailing the resubmitted claim? Resubmitted Non-Institutional 081 claims should be sent to:
081 Claims
P.O. Box 7050
Tallahassee, FL 32314-7050
* Do you have any questions about resubmitted claims that are not answered in this handbook? If so, please contact the Medicaid fiscal agent, Provider Inquiry for assistance at:
800-289-7799 (in Florida) 7:00 a.m.—6:00 p.m. or
800-955-7799 (outside Florida) 7:00 a.m.—6:00 p.m.
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