UB-04 claim adjustments

Quick reference guide

What is a claim adjustment?

  • A claim adjustment is a correction to a previously adjudicated and finalized claim
  • Adjustments are identified by the frequency code in the third position of the bill type. (Refer to the National Uniform Billing Committee Provider Manual for additional information)

DDE specific information

  • Complete a Claim Status Inquiry
  • from the Claim Status Inquiry Details page, click on ‘Correct this Claim’ to adjust claims. If the claim is located, the claim information auto populates in the Facility Claim Entry Application.
  • If the original claim cannot be found, then the user can key the claim using the Facility Claim Entry.

    • 837 specific information

    • Payer is reported in NM109 segment Loop 2010BC
    • Frequency code is reported in CLM05-3 2300 loop
    • Original claim number is reported in the REF 02 segment 2300 loop. If a vendor or clearinghouse is used, contact them for instructions on where to place the original claim number.

    Provider responsibilities

    • Submit the original claim number and frequency code adjustment indicator
    • Include remarks explaining the reason for requesting the correction
    • Submit corrections in a timely manner. Claim corrections submitted beyond timely submission requirements will be denied as provider liability. Providers must hold members harmless and may not bill the member

    Need more information?

    Additional information regarding claim adjustments is available in our Provider Manual.