Module Progress
0% Complete
DDE-Corrections, Adjustments, & Cancellations
- Choose 03/Claims Corrections
- Choose 53/Home Health Cancel
- Choose the claim to cancel by entering the HIC # and DOS – select the claim with a “U” for update
- On Page 1 key in the appropriate condition code—D5 or D6
- Scroll to page 03 and enter OT for the Adjustment Reason Code
- Press F9
Adjustments (03, 33)
- The original bill must have processed and be in the “P” status code before an adjustment can be made
- Final claims can be canceled or adjusted
- RAPs can only be canceled
- Choose 03/Claims Correction
- Choose 33/ Adjustment
- Choose the claim to adjust by entering the HIC # and DOS – select the claim with a “U” for update
- Enter the appropriate condition code to identify the reason for the adjustment. See the billing code sheet
- Make any necessary changes to the claim
- Go to Page 3 and enter OT in the Adjustment Reason Code
- Press F9
Note: You may not adjust a claim in Medical Review until it pays
Return To Provider – RTP
- Errors that can be fixed by the Provider
- Choose 03/Claims Correction
- Choose 27/Home Health
- Choose the claim to correct by entering the HIC # and DOS – select the claim with a “U” for update
- Make necessary changes
- Press F9
Purpose
- Incorrect Name Spelling
- Incorrect HIC #
- Overlap by another agency (PPA)
- RAP and Final Claim not matching (The four keys)
- ICD-10 Codes
- MA/HMO
- Overlap with hospital dates
- Auto cancel
- NPI
- 227 Receipts