When requesting a void, the provider must:
Resubmit a photocopy of the original claim or a new claim form;
Enter the items listed below;
Initial and date the form if it is a photocopy, or sign and date the form if it is a new form; and
Mail the void request to the fiscal agent for processing at:
Adjustments and Voids
P.O. Box 7080
Tallahassee, Florida 32314-7080
Billing instruction
BOX # 1 Void Enter a ―V‖ for a void.
Internal Control Number - Enter the most recently paid Internal Control Number (ICN) for the incorrectly paid claim. For a legacy claim that the prior Medicaid fiscal agent processed that has a 17-digit Transaction Control Number (TCN), enter the TCN.
Enter the ICN or TCN assigned to the paid claim in the upper left corner, above the top line of the form. Be sure to enter all the digits correctly. Enter the most recent ICN or TCN for the claim.
1a Recipient’s Medicaid ID No. - If using a new claim form, enter the recipient‘s ten-digit Medicaid ID Number
2 Recipient’s Name - If using a new claim form, enter the recipient‘s last name, first name and middle initial exactly as it appears on the gold plastic Medicaid ID Card or other proof of eligibility
31 Authorized Signature and Title - If using a new claim form, it must be signed. A photocopied form must be initialed and dated. The signature must be that of the provider, its employees or authorized billing agent.
31 Billing Date If using a new claim form, it must be dated. Use the month, day, year format: MM/DD/YY. Example: 08/21/06 for August 21, 2006
33 Biller Provider Info & PH # If using a new claim form, enter the billing provider‘s name, address, zip code plus 4, and telephone number.
33a NPI - If entering the pay to provider‘s NPI, enter it in this field. If the rendering provider‘s NPI is mapped to a taxonomy code that is needed to identify the provider in the Florida Medicaid claims processing system, the rendering provider must enter qualifier code ZZ and the taxonomy code in item 33b. If not entering the NPI, leave blank
33b Other ID # If entering the pay to provider‘s Medicaid provider number, enter it in this item preceded by the qualifier code 1D (qualifier code 1D stands for Medicaid provider number).
If entering the pay to provider‘s NPI in item 33a, and if the NPI is mapped to a taxonomy code that is needed to identify the provider in the Florida Medicaid claims processing system, enter qualifier code ZZ and the taxonomy code.
If the provider is a group provider, the group number must be entered and the individual treating provider number must be entered in item 24 J for each claim line billed
Learn Medical Billing Process, Tips to best AR Specialist. Medical Insurance Billing codes, Denial, procedure code and ICD 10, coverage guidelines. Demographic, charge, payment entry, AR process and eligibility and follow up. How to Guide.
Pages
- Home
- Medical Billing Question and Answer - Terms
- Insurance Denial Claim Appeal Guidelines.
- Medical Billing Downloads
- Understand Medical Billing
- Medical Billing Outsource
- Medicare Coverage and Plan Overview
- Advertise with us
- EVALUATION AND MANAGEMENT CPT code [99201-99499] - Full List
- Overall Medical billing process
- CPT Code 99201, 99202, 99203, 99204, 99205 - Which code to USE
- Internal Medical Billing Audit - how to do

Voiding Claims on a CMS 1500 Paper Claim Form - Medicaid
Labels:
Appeal Letter,
Medicaid,
Tips and Tricks
Subscribe to:
Post Comments (Atom)
Medical Billing Popular Articles
-
CPT CODE AND Description 99391 - Periodic comprehensive preventive medicine reevaluation and management of an individual including an age...
-
Procedure CODES and Descriptions 99401 - Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an indi...
-
CPT Code and description 99381 - Initial comprehensive preventive medicine evaluation and management of an individual including an age an...
-
When an ERA is received, providers may: •Post decision and payment information automatically, for individual claims included in an R...
-
Procedure code and Description 99251 Inpatient consultation for a new or established patient, which requires these 3 key components: A pro...
-
CPT code and description 80050 - General health panel This panel must include the following: Comprehensive metabolic panel (80053), ...
-
Medicare denial code and Descripiton 1 Deductible Amount 2 Coinsurance Amount 3 Co-payment Amount 4 The procedure code is inconsistent ...
-
93000-93010: Hone Your ECG Coding Skills With 3 Essential Pointers Whether you call them ECGs or EKGs, chances are you see a lot of elec...
-
Background: Type of Service (TOS) is an indicator that the contractor places on the Form CMS-1500 paper form or electronic format. The indic...
-
Billed amount: It is the Amount charged for each service performed by the provider. In other words it is the total charge value of the cla...

No comments:
Post a Comment