Are you going to resubmit the claim, make sure all the below points has been reviewd.


Resubmission Checklist


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

*  Did you wait thirty days after the original submittal before resubmitting a
missing claim?

* If using a photocopy of a claim, did you make sure it was legible and
properly aligned?

* 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?

*  If you have corrected or changed the original claim form, have strikeovers
been corrected on each copy? (Do not use whiteout.)

*  Has the resubmitted claim been signed again and dated?

*  Have you clipped all required attachments and documentation to the
claim form?

*  Is the claim clean of all highlighting and whiteout?

*  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:
081 Claims
P.O. Box 7050
Tallahassee, FL 32314-7050

*  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.