- Introduction
- Chapter I - Online System Terminology
- Chapter II - Online Menu Functions Overview
- Chapter III - Navigating the Online System
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Chapter IV - Inquiries Submenu (01)
- Accessing the Inquiries Submenu
- Beneficiary/CWF (10)
- DRG (Pricer/Grouper) (11)
- Claim Summary (12)
- Revenue Codes (13)
- HCPCS Codes (14)
- DX/Proc Codes ICD-9 (15)
- Adjustment Reason Codes (16)
- Reason Codes (17)
- ZIP Code File (19)
- OSC Repository Inquiry (1A)
- Claim Count Summary (56)
- Home Health Payment Totals (67)
- ANSI Reason Codes (68)
- Invoice Number/DCN Translator (88)
- DX Proc Codes ICD-10 (1B)
- Community Mental Health Centers Services Payment Totals (1C)
- Check History (FI)
- Provider Practice Address Query (1D)
- New HCPCS Screen (1E)
- Opioid Use Disorder (OUD) Demo 99 (1F)
- Chapter V - Claims and Attachments Submenu (02)
- Chapter VI - Claims Correction Submenu (03)
- Chapter VII - Online Reports View Submenu (04)
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Resources
- Part A Electronic Medicare Secondary and Tertiary Payer Specifications for ANSI Inbound Claim
- Electronic Medicare Secondary Payer Specifications for Inbound Claims
- FISS UB-04 Data Entry Payer Codes
- Common Claim Status/Locations
- FISS Reason Code Overview
- FISS Reason Code/Claim Driver Overview
- Program Function/Escape Key Crosswalk
- How to Adjust a Claim
- FISS Claim Change/Condition Reason Codes
- How to Cancel a Claim
- How to Correct a Return to Provider Claim
- Online System Menu Quick-Reference
Resources
How to Adjust a Claim
To adjust a claim using the FISS/DDE Provider Online System, follow these steps:
Step | Action |
---|---|
1 | Select the CLAIMS CORRECTION (03) submenu from the MAIN MENU |
2 | Key the appropriate option number from the CLAIM ADJUSTMENTS directory associated with the type of claim to be adjusted at the ENTER MENU SELECTION: prompt Valid entries are: 30 – Inpatient 31 – Outpatient 32 – Skilled nursing facility (SNF) 33 – Home health 35 – Hospice |
3 | Press <Enter> |
4 | Key in the MID number and dates of service for the claim you want to adjust Note: Keying in the date of service is optional. Note: You may have to enter the facility National Provider Identifier (NPI). |
5 | Press <Enter> |
6 | Select the claim you want to adjust by placing a "U” next to the claim record under the SEL field |
7 | Press <Enter> |
8 | Key in the appropriate claim change reason code in the COND CODE field on CLAIM PAGE 01 |
9 | Press <F8/PF8> to advance to CLAIM PAGE 03 |
10 | Key in the appropriate adjustment reason code in the ADJUSTMENT REASON CODE field on CLAIM PAGE 03 |
11 | Make all appropriate corrections to the claim |
12 | Press the <F9/PF9> key to store the adjustment |
13 | Verify that the adjustment was accepted by checking the status/location of the claim on the CLAIM SUMMARY INQUIRY option (01 submenu, option 12)
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Revised 9/13/2018