Sunday, October 3, 2010

CMS BOX 22 Medicaid Resubmission Code, Original Ref. No.

For Adjustments:

When requesting an adjustment to a paid claim, enter an “A” followed by the 13-character internal control number (ICN) assigned to the paid claim. This ICN appears on the remittance advice on which the original claim was paid. Please refer to Subchapter 5, Part 6, of your MassHealth provider manual for detailed billing instructions on claim status and correction.

For Resubmittals:

When resubmitting a denied claim, enter an “R” followed by the 13-character ICN assigned to the denied claim. This ICN appears on the remittance advice on which the original claim was denied.
Please refer to Subchapter 5, Part 6, of your MassHealth provider  manual for detailed billing instructions on claim status and correction.

Medicaid Resubmission Code Situational. If filing an adjustment or void, enter an “A” for an adjustment or a “V” for a void as appropriate AND one of the appropriate reason codes for the adjustment or void in the “Code” portion of this field. Enter the internal control number from the paid claim line as it appears on the remittance advice in the “Original Ref. No.” portion of this field. Appropriate reason codes follow:

Adjustments 

01 = Third Party Liability Recovery
02 = Provider Correction
03 = Fiscal Agent Error
90 = State Office Use Only – Recovery
99 = Other

Voids 

10 = Claim Paid for Wrong Recipient
11 = Claim Paid for Wrong Provider
00 = Other


To adjust or void a previously paid claim, use an adjustment or void reason code to complete the CODE area of Field 22 (MEDICAID RESUBMISSION). Resubmitting a denied claim is not considered an adjustment or void.

Adjustment/Void reason codes for Field 22

To adjust or void a previously paid claim, use an adjustment or void reason code to complete the CODE area of Field 22 (MEDICAID RESUBMISSION). Resubmitting a denied claim is not considered an adjustment or void.

Adjustment reason codes

Use one of the following codes in Field 22 when adjusting a previously paid claim.

Medicaid resubmission: Complete this field to adjust or void a previously paid claim. Otherwise, leave this field blank.

** In the Code area, enter an adjustment or void reason code (see section, Adjustment/Void reason codes for Field 22).

** In the Original Reference Number area, enter the last paid Internal Control Number (ICN) of the claim.

Adjustments and voids apply to previously paid claims only (including zero paid claims). resubmitting a denied claim is not considered an adjustment.


Resubmissions, replacements, and Voids

The AHCCCS Claims Processing system will deny claims with errors that are identified during the editing process. These errors will be reported to you on the AHCCCS Remittance Advice. You should correct claim errors and resubmit claims to AHCCCS for processing within the 12- month clean claim time frame (See Chapter 26, Correcting Claim Errors).

When resubmitting a denied claim, you must submit a new claim form containing all previously submitted lines. The original AHCCCS Claim Reference Number (CRN) must be included on the claim to enable the AHCCCS system to identify the claim being resubmitted. Otherwise, the claim will be entered as a new claim and may be denied for being received beyond the initial submission time frame.

You must resubmit any documentation that was sent with the denied claim.

You will resubmit a corrected claim when the original claim was denied or partially denied.

To resubmit a denied CMS 1500 claim:

Enter “A” in Field 22 (Medicaid Resubmission Code) and the CRN of the denied claim in the field labeled "Original Ref. No." Failure to resubmit a 1500 claim without Field 22 completed will cause the claim to be considered a “new” claim and will not link to the original denial. The “new” claim may be denied for timely filing exceeded.

Resubmit the claim in its entirety, including all original lines if the claim contained more than one line.

Note: Failure to include all lines of a multiple-line claim will result in recoupment of any paid lines that are not accounted for on the resubmitted claim.

Example:

You submit a three-line claim to AHCCCS. Lines 1 and 3 are paid, but Line 2 is denied. When resubmitting the claim, you should resubmit all three lines. If only Line 2 is resubmitted, the AHCCCS system will recoup payment for Lines 1 and 3.

To void a paid CMS 1500 claim enter “V” in Field 22 (Medicaid Resubmission Code) and the CRN of the claim to be voided in the "Original Ref. No." field.

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