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Printed Date: 9/22/2015
After submitting an acceptable credit balance report, providers may determine that a correction is needed on the information provided on the detail page accompanying their credit balance report, may determine that a refund of funds collected on a credit balance should be refunded, or would like to submit additional information to correct claim history after a credit balance demand letter has been issued.
Corrections to the detail page
If a provider determines that information submitted on the detail page of the credit balance report was incorrect, they may submit corrections using the Medicare Credit Balance Correction and/or Refund Form. If you find a correction is needed, Palmetto GBA encourages the submission of a correction form to ensure each claim reported is properly adjusted. Incorrect information may prevent the adjustment of the claim and result in a demand letter for the disclosed amount of the credit balance. Examples of corrections that need to be made would include the incorrect claim number, dates of service, patient's Medicare ID number, and/or credit balance amount. **Please note: This form should not be used in place of the detail page.
If a claim was reported in error or incorrect information was reported on the detail page resulting in inadequate information to identify the claim for adjustment and collection, Palmetto GBA will issue a credit balance demand letter to collect the amount disclosed on the detail page. Since the claim cannot be adjusted due to incorrect or missing information, the amount paid on the reported claim will still reflect the original paid amount and can be adjusted by the provider or other entities such as the RAC or ZPIC/UPIC. As a result, duplicate collection can occur. To ensure all claims can be adjusted, Palmetto GBA strongly encourages providers to review the information submitted on the detail page and be sure to include the hard copy UB04 form if you are requesting Palmetto GBA to initiate the claim adjustment. Timely submission of claim adjustments using the DDE process to ensure credit balances do not remain at the end of the calendar quarter is encouraged to avoid issues with reporting claim detail with the credit balance report. It is important to note that providers who have included claims on the detail page that have been electronically adjusted should monitor the status of the adjusted claim in case it has been sent back (RTP – Returned to Provider) and the adjustment was not completed. In the event that you find that a duplicate recoupment has occurred, please submit the Medicate Credit Balance Correction and/or Refund Form.
Requests to Adjust Claims after a Credit Balance Demand Letter has been Issued
If a Credit Balance demand letter has been received and you would like to request an adjustment to claim(s) that did not process correctly through claims processing which resulted in the demand letter, please complete the Medicare Credit Balance Demand Letter Claim Adjustment Request form.
Please see the form link(s) below:
CMS Regulation References
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Last Updated: 01/04/2018