Last Modified: 7/3/2020
Location: FL, PR, USVI
Business: Part A
Q. Can I adjust a claim that has been denied, which is in a 'D' status location in direct data entry (DDE)?
A. No. If a claim has been denied, the provider cannot submit an adjustment. Any attempted adjustments will reject with a reason code stating the claim cannot be adjusted.
A denial could result from edits in the fiscal intermediary shared system (FISS) or through a medical review.
Please follow the guidelines for the Appeals
process to submit a redetermination request.
Source: Provider Outreach and Education (POE) and Electronic Data Interchange (EDI)
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