How to Adjust Claims for Retro Rate Increase 

Jun 29, 2022

There are two ways you can update your claims to get reimbursed for a retro rate increase.   

Option One: Straight Reversal 

You can do a straight reversal, which takes back the original payment and allows you to bill a new clean claim. You have one year from the date of service to submit a correct claim. 

Select “reverse this claim only” for each claim you wish to update. You can then bill new clean claims.  

Use this option if your claim is over 120 days from the time it is displayed on your Remittance Advice (RA) as a paid claim, or 120 days from the date of the retro rate notice.   

Option Two: Adjustment 

The second option is to “adjust” claims. Use this option if your claim is within 120 days from the date your paid claim appears on an RA, or if your claim is within 120 days from the date we sent the retro rate notice. 

Please follow the steps below to adjust your claims: 

1. Click on the reverse and a box will pop up, defaulting to a claim adjustment. The radio button on the left is filled in, the middle box is checked, and the box to the right is empty. The message says, “Use this claim information as the basis for a new claim.”  

2. Select “Ok” and “Continue.” A second box pops up and asks if you are sure.  

3. Select “Yes,” indicating that you are sure. The system opens the claim for editing.  

4. Go to the charges box and change it from what you billed originally to what you should have been paid, (the higher amount on each line you bill).   

5. Click save and adjudicate.  

Claims that are adjusted using this process will have the same claim number as the original claim, but the claim number changes to include an R1 on the end for the reversal.  

The system will take back the original payment. The original claim number will have an A1 for the adjustment and will show the A1 claim at the higher amount. In essence, you are getting paid the difference. 

For questions, please email Provider Services or call 1-866-690-5585. TTY users dial 711.