Nonfinalized Claims That Were Cancelled or Adjusted
Adjustments or cancels should not be submitted electronically through EMC or Direct Data Entry (DDE) until you have seen the claim in a finalized location of PB9997 and on your remittance advice (RA).
It has come to our attention that some providers have initiated adjustments via EMC or DDE on claims that are not finalized in a PB9996 status location. This action results in money being recouped that hasn t been released to the provider.
If you have a claim where this has occurred, please send a hard copy UB-92 of the original claim to your Claim's Team Manager and in remarks on the claim please notate "Payment recouped but original claim did not pay". We will process your hard copy claim internally for payment and it will appear on a future RA. Do not resubmit your claim through EMC or DDE as it will auto-deny as a duplicate.
Regular Mailing Address: Claims Manager Diane Pierce
Page Last Updated: Tuesday, 15-Jul-2008 10:35:47 CDT
