Reason Code 30905

The adjustment claim submitted cannot be matched to a claim previously processed. Therefore, no adjustment can be performed.

Verify that the claim you want adjusted is in a finalized status (PB9997) prior to submitting an adjustment. Verify that the provider number, HIC number, from date and DCN on the adjustment claim match those same data elements on the remittance advice containing the original payment.

Verify billing and if appropriate, correct. F9 and resubmit the claim.

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Provider Contact Center: 855-696-0705

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