Tuesday, September 6, 2011

How to Resubmit a Denied Claim


Check the remittance voucher before submitting a second request for payment. Claims may be resubmitted for one of the following reasons only:

·  The claim has not appeared on a remittance voucher as paid, denied, or suspended for thirty days after it was submitted; or

·  The claim was denied due to incorrect or missing information or lack of a required attachment.

Do not resubmit a claim denied because of Medicaid program limitations or policy regulations. Computer edits ensure that it will be denied again.

No Response Received

If the claim does not appear on a remittance voucher within 30 days of the day it
was mailed, the provider should take the following steps:

·  Check recently received remittance voucher dates. Look for gaps. A remittance voucher may have been mailed but lost in transit. If the provider believes this is the case, call ACS Provider Inquiry.

·  If there is not a gap in the dates of remittance vouchers received, please call the Medicaid fiscal agent, Provider Inquiry. An associate will research the claim.

·  If the fiscal agent advises that the claim was never received, please resubmit another claim immediately. See the Resubmission Checklist on the following page in this chapter.

Note: See Requesting Help in this chapter for additional information on obtaining assistance from the fiscal agent

Correcting a Denied Claim

If the claim has been denied for incorrect or missing information, correct the errors before resubmitting the claim.

New or Photocopied Claims

A claim may be resubmitted on a new claim form or legible photocopy. Correct errors with correction tape by covering the incorrect information and writing the correct information on top of the tape. Do not use whiteout or highlight areas because they cannot be imaged correctly. Attach requested documentation prior to resubmitting. Photocopies must contain an original signature and date. Claims and attachments that cannot be clearly imaged will be returned.

Resubmission Checklist

Use the following checklist to ensure that resubmittals are completed correctly before submitting.

  1.  Did you wait thirty days after the original submittal before resubmitting a missing claim?
  2.  If using a photocopy of a claim, did you make sure it was legible and properly aligned?
  3.  If you chose to fill out a new claim, did you type or print the form in black ink? Are all multi-part copies legible?
  4.  If you have corrected or changed the original claim form, have strikeovers been corrected on each copy? (Do not use whiteout.)
  5.  Has the resubmitted claim been signed again and dated?
  6.  Have you clipped all required attachments and documentation to the claim form?
  7.  Is the claim clean of all highlighting and whiteout?
  8.  Do you have the correct P.O. Box Number and corresponding nine-digit zip code for mailing the resubmitted claim? Resubmitted Non- Institutional 081 claims should be sent to:

P.O. Box 7050
Tallahassee, FL 32314-7050

q Do you have any questions about resubmitted claims that are not answered in this handbook? If so, please contact the Medicaid fiscal agent, Provider Inquiry for assistance at:

800-289-7799 (in Florida) 7:00 a.m.—6:00 p.m. or
800-955-7799 (outside Florida) 7:00 a.m.—6:00 p.m.

No comments:

Post a Comment

Popular Posts