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Claim Adjustment Request 151 Form Please Mail Form To: P.O. Box 27401 Richmond, VA 23279-7401 Provider #: Please complete all sections of this form to assist us when researching your adjustment request.
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What is claim adjustment request?
Claim adjustment request is a request made by a healthcare provider to adjust or correct a previously submitted claim.
Who is required to file claim adjustment request?
Healthcare providers are required to file claim adjustment request.
How to fill out claim adjustment request?
To fill out a claim adjustment request, healthcare providers need to provide details of the original claim, the reason for the adjustment, and any supporting documentation.
What is the purpose of claim adjustment request?
The purpose of claim adjustment request is to correct errors or make changes to a previously submitted claim, such as updating patient information or adding additional services.
What information must be reported on claim adjustment request?
Information reported on claim adjustment request includes the original claim number, reason for adjustment, dates of service, and any additional charges or payments.
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