Adjustments/Cancels
Adjustments (type of bill XX7) to claims are made when it is necessary to change information on a previously processed claim. The change must impact the processing of the original bill or additional bills in order for the adjustment to be performed. The claim being adjusted must be in a finalized status.
A cancellation (type of bill XX8) to a claim may be necessary when the incorrect provider number was submitted, an incorrect HICN was submitted, or a duplicate payment was received. The claim being canceled must be in a finalized status, defined as appearing in FISS status/location (S/LOC) P B9997.
Claim adjustments can be made to paid or rejected claims (i.e., status/location P B9997 or R B9997). If a claim in a P status has been reviewed by Medical Review and has one or more line items denied, adjustments can be made to the paid line items. Please note: Adjustments cannot be made to any part of a denied line item on a partially paid claim.
For home health providers, it is not appropriate to adjust Requests for Anticipated Payment (RAPs). For hospice providers, is it not appropriate to adjust Notices of Election (NOEs). Incorrect RAPs and NOEs must be canceled and resubmitted with the correct information. Additional information for hospice providers can be found on the Canceling a Notice of Election or Benefit Period Web page.
For
additional information for home health providers, refer to theMedicare
Claims Processing Manual (CMS Pub. 100-04), Ch. 10, §10.1.11. 
Limitation on Recoupment (935) Overpayments
The limitation on recoupment (935), as required by Section 935 of the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) changes
the process by which Cahaba can recoup an overpayment resulting from a
postpayment adjustment, such as a denial or Medicare Secondary Payer (MSP)
recovery. For additional information, refer to the “Limitation
on Recoupment (935) for Provider, Physicians and Suppliers Overpayments” Medicare
Learning Network (MLN) Matters article, MM6183 or by viewing the official
instruction, Change
Request 6183.
Additional Cahaba Resources
- Refer to Cahaba’s online course Adjusting and Canceling Claims to learn more about adjusting or canceling claims.
- Refer to the Claims Correction Menu section of the FISS Reference Guide for information about how to submit claim adjustments or cancellations using the Fiscal Intermediary Standard System (FISS).
Page last updated: September 30, 2008
