APD Zendesk


Does the provider have to void claims when the service authorization is in rejected status?

In some instances, the provider may have to void one or more claims to fix a rejected SA. For example:

L3 - Line item not found
     Definition:  A balance in FMMIS is zero
          Fix:  If funds were added to the SA, the provider needs to void the last paid claim. Then the SA needs to be re-sent to FMMIS to update the PA balance

75 - Sum of claims greater
     Definition:  SA allocation is lower than what the provider has billed on the PA in FMMIS
          Fix:  Check PA claims in FMMIS to see if the provider has over billed or increase the allocation on SA to at least the amount of the paid claims

If the provider has overbilled, then that amount would need to be voided.

79 - no description given
     Definition:  SA has been cancelled in ABC, but not in FMMIS due to the fact that the provider has billed against the PA
          Fix:  Check FMMIS to find the PA and re-create the SA in ABC. Email APD Help Desk with a request to have the PA number re-assigned. Address the issue of whether or not the provider was authorized to bill

If the provider was not authorized to bill then these claims may need to be voided.

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