Identifying Adjustments and Voids on the Remittance Voucher

Adjustments on the Remittance Voucher

Adjustment requests are printed on the remittance voucher as two different claim entries.

The incorrectly paid claim is listed exactly as it was when it was originally reported. The transaction control number (TCN) for this entry is not the same as the original claim, but is a system-assigned, unique “credit” TCN. The original incorrect payment is credited back to Medicaid’s account. A minus symbol ( - ) appears just to the right of the incorrectly paid amount. The adjusted request is printed directly following the original claim entry.

Incorrect claim information on the original now shows as corrected. The difference between these two entries is the “NET” amount on the remittance voucher.

An Adjustment Reason Code (ADJ-R) and the TCN of the claim being adjusted are listed following the two claim entries. Adjustment reason codes are defined in the summary section of the remittance voucher.

Voids on the RV 

Void requests are printed as one claim entry. The entire claim is displayed and the payment amount is returned to Medicaid. A minus symbol ( - ) appears next to the amount.

Adjustment or Void Reason Codes

An Adjustment Reason Code appears with each adjustment or void shown on the remittance voucher. These numeric codes are explained on the remittance voucher.

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