Credit Balance Report Related Adjustments or Cancelations

When submitting a claim adjustment for an individual credit balance, complete the field locators (FL) required on an adjustment UB-04 claim or electronic equivalent. This includes the:

• Type of Bill (FL 4), with the third digit of "7"
• Condition Code (FL 18-28)
• You must enter an explanation of the adjustment in the Remarks field (FL 80) i.e., Refund to Medicare
• Adjustment Reason Code on (FISS Page 03) must be a "CB" 
• Document Control Number (FL 64) of the claim being adjusted

When submitting a claim cancelation for an individual credit balance, complete the field locators (FL) required on a cancelation UB-04 claim or electronic equivalent. This includes the:

• Type of Bill (FL 4), with the third digit of "8"
• Condition Code (FL 18-28) "D5" – cancel to correct provider/patient's Medicare ID # or "D6" — cancel duplicate payment
• You must enter an explanation of the cancelation in the Remarks field (FL 80) i.e., Refund to Medicare
• Document Control Number (FL 64) of the claim being canceled