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.

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