Fillable Adjustment/Correction

Description
Adjustment/Correction Mail to: 30 W. Spring St. Columbus, OH 43215-2256 Do Not Write In This Space 1. Transaction control number to be adjusted/corrected (17 digits) 2. Provider number 4. Claim number 7. Correction - Complete only those items listed incorrectly or omitted on the remittance Line # advice a. Claim number b. Date(s) of service c. Procedure/drug code-billed amount c. Procedure/drug code-billed amount...
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