RA Requirements for Paper Adjustments
• Paper adjustment processing procedures require that providers attach a copy of all paper Medicaid RA pages related to the referenced claim.
• A provider-generated RA, or a copy of the electronic RA (835 transaction) is not an acceptable substitute for the paper copy mailed to providers by HP Enterprise Services. Provider-generated RAs have varied formats and do not include all information necessary for manual adjustment processing.
• Paper adjustments that do not include the required RA will be denied with EOB 812, “Adjustment denied. Please refile with all related RA’s, including original processing.” Providers receiving this denial should resubmit a copy of their adjustment with the requested RA.
• If you do not have a copy of the paper RA, contact HP Enterprise Services Provider Services to request a replacement. (There is a per-page charge for RA requests that are more than 10 checkwrites old. RA reprints for the last 10 checkwrites are provided at no charge. Refer to How to Request a Duplicate Remittance and Status Report in Section 9, Remittance and Status Report, for additional information.)
Submitting an Adjustment Electronically
With the implementation of standard claims transactions to comply with the Health Insurance Portability and Accountability Act (HIPAA), adjustments may be filed electronically. Electronic adjustments are the preferred method to report an overpayment or underpayment to NC Medicaid. There are two separate actions that may be filed:
1. Void—in order to file a claim to be voided, the provider must mark the claim as a voided claim using the Claim Submission Reason Field (Dental and CMS-1500) and Type of Bill (UB-04) on the 837 electronic claim transaction. The ICN for the original claim to be voided must also be provided. When processed, the claim associated with the original ICN will be recouped from the patient’s record and the payment will be recouped from the provider’s RA.
2. Replacement—a replacement claim may be filed by completing a corrected electronic claim and marking the claim as a replacement using the Claim Submission Reason Field (Dental and CMS-1500) and Type of Bill (UB04) on the electronic claim transaction. The ICN for the original claim to be replaced must also be provided. The original claim will be recouped from the patient’s record and shown as a recoupment on the RA when the replacement claim processes and pays without error. If the replacement claim is denied, the entire replacement process will be denied, including the recoupment.
N.C. Medicaid will continue to accept and process paper adjustments. Although adjustments may be filed electronically, providers are advised to file adjustments on paper when paper documentation is required.
• Paper adjustment processing procedures require that providers attach a copy of all paper Medicaid RA pages related to the referenced claim.
• A provider-generated RA, or a copy of the electronic RA (835 transaction) is not an acceptable substitute for the paper copy mailed to providers by HP Enterprise Services. Provider-generated RAs have varied formats and do not include all information necessary for manual adjustment processing.
• Paper adjustments that do not include the required RA will be denied with EOB 812, “Adjustment denied. Please refile with all related RA’s, including original processing.” Providers receiving this denial should resubmit a copy of their adjustment with the requested RA.
• If you do not have a copy of the paper RA, contact HP Enterprise Services Provider Services to request a replacement. (There is a per-page charge for RA requests that are more than 10 checkwrites old. RA reprints for the last 10 checkwrites are provided at no charge. Refer to How to Request a Duplicate Remittance and Status Report in Section 9, Remittance and Status Report, for additional information.)
Submitting an Adjustment Electronically
With the implementation of standard claims transactions to comply with the Health Insurance Portability and Accountability Act (HIPAA), adjustments may be filed electronically. Electronic adjustments are the preferred method to report an overpayment or underpayment to NC Medicaid. There are two separate actions that may be filed:
1. Void—in order to file a claim to be voided, the provider must mark the claim as a voided claim using the Claim Submission Reason Field (Dental and CMS-1500) and Type of Bill (UB-04) on the 837 electronic claim transaction. The ICN for the original claim to be voided must also be provided. When processed, the claim associated with the original ICN will be recouped from the patient’s record and the payment will be recouped from the provider’s RA.
2. Replacement—a replacement claim may be filed by completing a corrected electronic claim and marking the claim as a replacement using the Claim Submission Reason Field (Dental and CMS-1500) and Type of Bill (UB04) on the electronic claim transaction. The ICN for the original claim to be replaced must also be provided. The original claim will be recouped from the patient’s record and shown as a recoupment on the RA when the replacement claim processes and pays without error. If the replacement claim is denied, the entire replacement process will be denied, including the recoupment.
N.C. Medicaid will continue to accept and process paper adjustments. Although adjustments may be filed electronically, providers are advised to file adjustments on paper when paper documentation is required.
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