were reported on the Medicaid Remittance Advice. The reason for the claim denial or payment reduction is reported on the Medicaid Remittance Advice (see 471-000-85). The claim adjustment request is used to request reconsideration of the payment or denial, correct ...
PROVIDERS BILLING PAPER CLAIMS USING THE CMS 1500 CLAIM FORM WITH ONLY THE SCREENING CODES MUST NOW SUBMIT THE KM-3 CLAIM FORM WITH ALL DETAIL INFORMATION. EDUCATIONAL EDITS (517 AND 518 OR HIPAA ADJUSTMENT REASON CODE 16 FOR 835 ELECTRONIC RA) CURRENTLY APPEAR ON ANY ELECTRONIC AND HARD COPY...
Providers should submit an adjustment for APRN claims that did not have the required Designated Physician's NPI included in the appropriate location on the previously paid claim. This can be done by paper using the 213 Adjustment Form or electronically via the 837P adjustment format. The Designate...
The MHD subgroup were identified if they had at least one inpatient claim or at least two outpatient claims featuring International Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes indicative of selected mental/behavioural health conditions, or if they had at least two outpatient ...