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6.1.3.2 Adjustments to Claims
The title, "Adjustments to Claims," is centered at the top of each page in this section. Adjustments are listed by claim type, client name, and CSHCN Services Program client number. Media types 011, 021, 031, 041, 051, 071, and 081 appear in this section. An adjustment prints in the same format as a paid or denied claim.
The adjusted claim is listed first on the R&S report. EOB 00123, "This is an adjustment to previous claim XXXXXXXXXXXXXXXXXXXXXXXX which appears on R&S report dated XX/XX/XX" follows this claim. The dollar amounts on the original claim are followed by a minus (-) symbol indicating the original payment is voided. The net adjustment amount is the difference between the claim total for the original claim and the claim total for the adjusted claim. If the total amount of money to be recouped is not available on the current R&S report, it is taken from future payments. EOB 00601 prints the following message below the claim indicating the amount is to be recouped later: "A receivable has been established in the amount of the original payment: $_______. Future payments will be withheld or reduced until such amount is paid in full."
When an adjustment is set up (EOB 00601), and enough money is available on the next R&S report, EOB 00097 prints, "Payment adjusted on following client." The original ICN and R&S report date appears. The dollar amount to be recouped is listed in the Original Amount column. The amount changes until all money is recouped.
In the "Adjustments to Claims" section, the amount identifying the net difference (difference between the original claim payment and the adjusted claim payment) appears below the prior claim payment. If the net difference is a positive amount, the amount is added to the amount of the current check. If the net difference is a negative amount, a minus sign appears before the dollar amount, and that amount is deducted from the amount of the current check.
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