Claims Processing and the Remittance AdviceOctober 13, 2014
Some of these codes may identify adjustments, which refer to any changes that relate to how a claim is paid differently from the original billing. There are seven general types of adjustments: 1. Denied claim; 2. Zero payment; 3. Partial payment; 4. Reduced payment; 5. Penalty applied; 6. Additional payment; and 7. Supplemental payment. Both assigned and non-assigned claims may be returned as unprocessable before a reimbursement decision is made if they contain claim errors (for example, incomplete or invalid information). You will receive a letter of explanation or a RA that provides information on claim errors. After the claim has been corrected, you must resubmit it as a new claim within the timely filing period. A claim that has been returned as unprocessable may not be appealed. You may appeal initial claim determinations, including denials, if you are dissatisfied with the claim determination and file a timely appeal request that contains the necessary information needed to process the request. If a denial is due to a minor error or omission you made in filing a claim, you may request a reopening to correct such clerical errors. A reopening is separate and distinct from the appeals process. After the claim has been corrected, you must resubmit it within the timely filing period. CMS.gov Claims processing share
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