Only a paid claim can be adjusted or voided.

If a paid claim must be adjusted, almost all data can be corrected through an adjustment with the exception of the Provider Identification Number and the Recipient/Patient Identification Number. Provider numbers and recipient Medicaid numbers cannot be changed. If it is necessary to make a correction to the provider number or recipient number, the claim must be voided and resubmitted correctly.

For those claims where multiple services are billed and paid by service line, only one claim line can be adjusted/voided per form. A separate adjustment/void form is required for each claim line if more than one claim line on a multiple line claim form needs to be adjusted or voided.

The provider should complete the information on the adjustment/void exactly as it appeared on the original claim, changing only the item(s) that was in error.

If a paid claim is being voided, the provider must enter all the information from the original claim exactly as it appeared on the original claim. After a voided claim has appeared on the Remittance Advice, a corrected claim may be resubmitted (if applicable).

When an Adjustment/Void Form has been processed, it will appear on the Remittance Advice under Adjustment or Voided Claim. The adjustment or void will appear first. The original claim line will appear in the section directly beneath the adjustment/void section.

An Adjustment/Void will generate Credit and Debit Adjustments which will appear in the Remittance Summary on the last page of the Remittance Advice.

Billing Instructions, including instructions for adjustments/voids, are located on the web site directory link, Billing Information.