Adjustment/Void Workshop Presented by Mina Reynaga & Kristen Brice Provider Field Representatives.
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Transcript of Adjustment/Void Workshop Presented by Mina Reynaga & Kristen Brice Provider Field Representatives.
Adjustment/Void Workshop
Presented byMina Reynaga & Kristen BriceProvider Field Representatives
Call 505-246-0710 or 800-299-7304 - to directly reach all provider help desks including Provider Relations, Provider Enrollment, the HIPAA/EMC help desk and TPL.For all contact, Claims, and Correspondence Addresses information go to the following link on the New Mexico Medicaid Web Portal:
• https://nmmedicaid.acs-inc.com/nm/general/loadstatic.do?page=ContactUs.htm
• Email: [email protected]
Contact Xerox
Important State Websites
STATE WEBSITE:PROGRAM POLICY MANUAL
• http://www.hsd.state.nm.us/mad/policymanual.html
BILLING INSTRUCTIONS• http://www.hsd.state.nm.us/mad/billinginstructions.html
REGISTERS AND SUPPLEMENTS:• http://www.hsd.state.nm.us/mad/registers/2012.html
Xerox Field Representative
Provider Field Representative: Mina Reynaga- (505) 246-9988 Ext. 8131233 Kristen Brice-(505) 246-9988 Ext. 8131216
• E-mail: [email protected]• E-mail: [email protected]
• Cc: [email protected]
4
When is it necessary to fill out an adjustment form for a claim?
6September 2009
• Claims paid incorrectly must be adjusted.
• DO NOT resubmit a denied claim with an adjustment sheet attached.
Adjustments
7September 2009
Adjustments will not be considered unless submitted on the adjustment request form with the following attached:
• Copy of the remittance advice.• Corrected claim.
Adjustments
8September 2009
Adjustments – Filing Limit
• Requests to adjust a claim must be submitted within 90 days from the date on the RA for the paid claim.
Completing an Adjustment/Void Form
10
Adjustment/Void Request Form
11September 2009
Medicaid Claim Adjustment
Always fill out the corrected claim (replacement claim) exactly as the claim was originally filed with the exception of the information being changed.
12September 2009
X
ALWAYS FILL IN THE INFORMATION BOXES BELOW
THIS INFORMATION IS FROM THE TCN THAT PAID INCORECTLY
13September 2009
What is a Transaction Control Number (TCN)?
The TCN is a unique number assigned to each and every claim. This number contains information about the claim and can be used to identify your claim when calling provider services
30825900085000001
The first digit indicates what the claim “media” is:
2 = electronic crossover
3 = other electronic claim
4 = system generated claim or adjustment
8 = paper claim
The last two digits of the year the claim was received
The numeric day of the year.
This is the Julian Date - this represents the date the claim was received by ACS: this claim - the 323rd day of 2008, or November 18, 2008
Batch number
The claim number within the batch.
30832300085000001
What is a Transaction Control Number (TCN)?
14
The twelfth digit in an adjustment/ void TCN will either be:
1= Debit2= Credit
15
WHY DO YOU WANT TO ADJUST THIS CLAIM? WRONG DATE OF SERVICE, WRONG AMOUNT OF UNITS, WRONG PROC CODE, FORGOT MODIFIER…….
“LINE 2, PROCEDURE CODE INCORRECT. CHANGE TO 99432 – SEE CORRECTED ATTACHED CLAIM.
X
ALWAYS SIGN FORMALWAYS DATE FORM
16
05 15 08 05 15 08 99431 1282 00
500 00X
11
Optional Optional
RequiredSituational
Provider Med Gp 505 333-44441234 Rocky RoadMountain View, NM 8888
05 15 08 05 15 08 99432 1125 0011
05 15 08 05 15 08 99238 1 93 0011
1234567890
TAXONOMY
ZZ363LF0000X
BILLING PROVIDER’S NPI
1234567890
RENDERING PROVIDER’S NPIFILL OUT CLAIM EXACTLY AS IT WAS PREVIOUSLY FILLED OUT, WITH THE EXCEPTION OF THE CHANGES (ADJUSTMENTS) YOU WILL BE MAKING.
Qualifier
17
Adjustment – CMS-1500
18September 2009
Claim Detail
You can also attach this page with your Void\Adjustment Request form.
19September 2009
X
ALWAYS FILL IN THE INFORMATION BOXES BELOW
THIS INFORMATION IS FROM THE TCN THAT PAID INCORECTLY
20September 2009
WHY DO YOU WANT TO ADJUST THIS CLAIM? WRONG DATE OF SERVICE, WRONG AMOUNT OF UNITS, WRONG PROC CODE, FORGOT MODIFIER…….
“LINE 2, REVENUE CODE 0250 HAD 4 UNITS. CHANGE TO 5 UNITS, $99.64 – SEE CORRECTED ATTACHED CLAIM.
X
ALWAYS SIGN FORMALWAYS DATE FORM
21September 2009
Provider Name Street City, State Zip 05/15/2008 05/17/2008
111
01/01/1931 F 05/15/2008 01
Clara Client
80 2
Required if pay to isdifferent than physicaladdress.
Adjustment - UB-04
0170 051508 2 1,326 000250 051508 5 99 640301 051508 3 187 000302 051508 3 134 00
22
1234567890
B3 332S00000X
MEDICAID
123456789
1 1 1746 64
NPI #
TAXONOMYQUALIFIER
0001 08031007
CLARA CLIENT
9431
1234567890ATTENDING ALAN
FILL OUT CLAIM EXACTLY AS IT WAS PREVIOUSLY FILLED OUT, WITH THE EXCEPTION OF THE CHANGES (ADJUSTMENTS) YOU WILL BE MAKING.
23September 2009
Adjustment – UB-04
24September 2009
Adjustments – Filing Guidelines Recap
• Complete Adjustment/Void form.
• Fill out corrected claim (CMS1500, UB04, or ADA 2006).
• Complete all information as it was on the claim previously submitted, with the exception of the changes being made.
• Attach a copy of the page of the RA in which the claim paid incorrectly.
• Mail to Xerox PO Box 27460 Albuquerque, NM 87125-7460, Attn: Claims Adjustment (keep a copy for your files).
Completing an Adjustment/Void Form
26September 2009
X
ALWAYS FILL IN THE INFORMATION BOXES BELOW
THIS INFORMATION IS FROM THE TCN THAT PAID INCORECTLY
27September 2009
CLAIM WAS BILLED INCORRECTLY
PLEASE VOID CLAIM
X
ALWAYS SIGN FORMALWAYS DATE FORM
28September 2009
RA for Void
29September 2009
Claim Detail
You can also attach this page with your Void\Adjustment Request form.
30September 2009
Adjustments – Filing Guidelines Recap
• Complete Adjustment/Void form.
• Fill out corrected claim (CMS1500, UB04, or ADA 2006).
• Complete all information as it was on the claim previously submitted, with the exception of the changes being made.
31September 2009
Adjustments – Filing Guidelines Recap continued-
• Attach a copy of the page of the RA in which the claim paid incorrectly.
• Mail to Xerox PO Box 27460 Albuquerque, NM 87125-7460, Attn: Claims Adjustment (keep a copy for your files).
• Do not send in a check with your void request.