National Government Services Logo

Note: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material which is copyrighted by the American Medical Association (AMA). You are forbidden to download the files unless you read, agree to and abide by the provisions of the copyright statement. Read the copyright statement now (you will be linked back to here).

   
Process for Provider Request to Cancel a Claim with Medical Review (MR) Denied or Down-coded Line(s)

Process for Provider Request to Cancel a Claim with Medical Review (MR) Denied or Down-coded Line(s)

 

Background:  Providers are unable to electronically cancel a claim with Medically Reviewed (MR) denied line(s).

For claims that have no MR denied or down-coded line(s), submit the cancel request electronically or through normal claim submission channels.

For claims that have an MR denied or down-coded line(s), submit the following information with a reopening request to cancel to the attention of the Appeals Department at the appropriate address (listed below):

  1. UB-04 with type of bill XX8
  2. Specific reason for canceling the claim
  3. Stating “billed in error” does not provide sufficient justification for canceling the claim. The request will be dismissed.
  4. No medical records are required

 

CA, MI, VA, WI, WV Providers
P.O. Box 7149
Indianapolis, IN 46207-7149

ME, MA, NH, NY Providers
P.O. Box 4711
Syracuse, NY 13221-4711

OH Providers
P.O. Box 7141
Indianapolis, IN 46207-7141

IL, IN, KY Providers
P.O. Box 7138
Indianapolis, IN 46207-7138

Posted: 04/15/2008

CMS Logo
CPT codes, descriptions, and other data only are copyright 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Apply.