Module 1, Topic 1
In Progress

Day 2: Claims Correction

Petria September 3, 2020

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