Resubmitting Claims That Are "Adjusted Payment"


Originally from ticket #106.


I am K's billing agent. I hope you can help us with this

We have been using your software for about three months and at the
beginning we weren't getting all the feedback we needed so our information
about the claims that had been rejected or paid or adjusted wasn't properly
getting into our inbox.

Everything seems to be all right at the moment but we made some mistakes
with the claims that now we don't know how to fix.

Indeed, most of our claims have been labeled as "adjusted payment" instead
of "rejected" due to an error when linking the code E083 to codes like
C122, C123, C132. We only used one date for the E083's and then linked them
to all the other service codes that applied to them so at the end the
MOHLTC has only paid for the one that matches the date of the service code
on that specific date and not for the other ones.

Now we know we have to link every E083 code to every single service code
when applies. We would like to fix the past mistakes though.

The question is: how can we fix this since if we want to submit the claim
again it will show as if we are trying to get paid for all the c122's,
C123's and C132's because we can not just submit only the E083's without
linking them to a service code.

Thanks for your help.


Hello F.

You will need to submit an RA inquiry form to the Ministry of health to "manually" adjust the claims submitted, but need fixing. You can obtain explicit instructions from your Claim Assessor - you will need to contact your local district office and ask form him/her.

Hope this helps

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