|
Last Modified: 10/7/2011
Location: FL, PR, USVI
Business: Part A
Claim information change inquiry
Do you need to change or correct information on a claim?
You have the capability to make changes to your claims, e.g., removing a modifier or procedure code, to correct the amount of units, etc. Below are the instructions on adjusting a claim through direct data entry (DDE), which can be located in the DDE manual 
:
:• From the main menu choose option 3 -- Claim and attachments correction menu
• Select the option on this menu that's appropriate for your type of bills. For example:
1. Inpatient -- 30
2. Outpatient -- 31
3. Skilled nursing facility (SNF) -- 32
• Enter the health insurance claim (HIC) number, change the status code to a "R" or "P," and key in the from and to dates of service, and then press enter. The system will automatically default the type of bill (TOB) frequency to an xx7. The HIC number field is now protected and may no longer be changed.
• Indicate why you are adjusting the claim by entering the claim change condition code, on page 01 of the claim and a valid adjustment reason code on page 03.
• Give a short explanation of the reason for the adjustment in the remarks section on page 04 of the claim.
• Press 'F9' (function key) to update/enter the claim into DDE for reprocessing and payment consideration. Claims that are adjusted will show on the claim summary screen, which is option 12 from menu 01.
• Check your remittance advice to ensure the claim adjusted properly.
Review the instructions outlined in the Centers for Medicare & Medicaid Services (CMS) internet only manuals (IOM), publication 100-04, Chapter 25 -- completing and processing the form CMS-1450 
data set to make sure you're completing the required fields within your claims.
data set to make sure you're completing the required fields within your claims.
Please use your browser's back button to return to the referring page.Source: FCSO Education Action Team
