Adjustments to Paid Claims

After review of both the claim and the Explanation of Benefits (EOB) Remittance Advice Report, a provider may determine that a claim needs to be adjusted. Providers may file adjustment requests to:

• Correct billing or processing errors.
• Correct inappropriate payments (overpayments and underpayments).
• Supply additional information that may affect the amount of reimbursement.

Adjustments are classified in two separate categories, check-related (refund) or non-check related, and further categorized as full or partial. Refer to Chapter 9 of the Provider Billing Manual for more information.

Forms

Providers may initiate reconsideration of a paid claim by submitting an appropriate Adjustment Request Form to Oklahoma Medicaid.

• HCA-15 - CMS-1500, Dental, Outpatient Crossover Part B Adjustment Request
• Pharm-3 - Pharmacy Paid Claim Adjustment Request
• HCA-14 - UB-92 and Inpatient/Outpatient Adjustment Request

Telephone request for adjustments are not allowed due to federal and state rules. For additional information or questions please Contact Us 1-800-522-0114, option 3, sub-option 1. Monday, Wednesday thru Friday 7:30 a.m. - 4:00 p.m., Tuesday 12:00 p.m. - 4:00 p.m.

Refunding or returning money

Refund checks must be written to the order of:

Oklahoma Health Care Authority
OHCA Finance Unit
P.O. Box 18299
Oklahoma City, OK 73154