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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 6: Claims Filing : 6.11 Remittance and Status (R&S) Report : 6.11.4 R&S Report Section Explanation : 6.11.4.2 Adjustments to Claims

6.11.4.2
Adjustments to Claims
Adjustments – Paid or Denied is centered at the top of each page in this section. Adjustments are sorted by claim type and then patient name and Medicaid number. Media types 011, 021, 031, 041, 051, 061, 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. Immediately below is the claim as originally processed. An accounts receivable is created for the original claim total as noted by EOB 00601, “A receivable has been established in the amount of the original payment: $XXX,XXX,XXX.XX. Future payments will be reduced or withheld until such amount is paid in full.” prints below the claim indicating the amount to be recouped. This amount appears under the heading, “Financial Transactions Accounts Receivable.” EOB 06065, “Account Receivable is due to the adjusted claim listed. For details, refer to your R&S Report for the date listed within the original date field.”
Claims adjusted as a result of a rate change will be listed on the R&S Report with EOB 01154 "This adjustment is a result of a rate change."
Refer to:
Subsection 6.2.5, “Modifier Requirements for TOS Assignment” in this section for a list of the most commonly used modifiers.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2011 American Medical Association. All rights reserved.