Get the free Institutional Claim Adjustment - BCBSND

Print Form Fax to: (701) 2772132 Mail to: BCB SND Attn: Provider Service 4510 13th Ave S Fargo, ND 58121 Institutional Claim Adjustment Use this form to request adjustments to services submitted on

How to fill out institutional claim adjustment

How to fill out institutional claim adjustment:

1. Gather necessary information: Before filling out an institutional claim adjustment, gather all the required information such as the patient's demographics, insurance information, diagnosis codes, procedure codes, and any supporting documentation.
2. Choose the appropriate form: Depending on your insurance company or payer, there may be specific claim adjustment forms required. Make sure to use the correct form for the specific claim adjustment you are submitting.
3. Provide accurate patient information: Fill in the patient's name, address, date of birth, insurance identification number, and any other required personal information accurately. Any discrepancies may result in claim denials or delays.
4. Include the claim details: Provide all the necessary information related to the claim adjustment, including the original claim number, date of service, the reason for adjustment (e.g., corrected coding, additional services, billing error), and any supporting documentation to justify the adjustment.
5. Accurately code the claim adjustment: Ensure that the diagnosis and procedure codes used for the claim adjustment accurately reflect the services provided. Any incorrect coding may lead to claim denials or delays.
6. Calculate the adjustment amounts: If the claim adjustment involves a change in the billed amount or reimbursement, calculate the correct adjustment amount based on the payer's payment policies. This may include deductibles, copays, or adjustments for contracted rates.
7. Attach supporting documentation: Depending on the nature of the claim adjustment, it may be necessary to provide additional documentation to support the adjustment being made. This could include medical records, operative reports, or any other relevant documents requested by the payer.

Who needs institutional claim adjustment:

1. Healthcare providers: Institutional claim adjustment is required by healthcare providers such as hospitals, clinics, nursing homes, and other institutional healthcare organizations. These providers submit claim adjustments to correct errors in previously submitted claims or to request additional reimbursement for services provided.
2. Insurance companies and payers: Insurance companies and payers also need institutional claim adjustments to process changes to previously adjudicated claims. These adjustments allow them to update payment amounts or correct any coding errors that may have been made.
3. Patients and policyholders: Institutional claim adjustments can also benefit patients and policyholders. If a claim was initially denied or underpaid, a claim adjustment can help correct the error and ensure appropriate reimbursement for the services received.

In summary, filling out an institutional claim adjustment requires gathering all necessary information, choosing the appropriate form, providing accurate patient information, including claim details and accurate coding, calculating adjustment amounts, and attaching any required supporting documentation. Both healthcare providers and insurance companies, as well as patients and policyholders, may need institutional claim adjustments to correct errors or update previously adjudicated claims.

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What is institutional claim adjustment?

Institutional claim adjustment is the process of correcting errors or discrepancies in a previously filed institutional claim.

Who is required to file institutional claim adjustment?

Healthcare facilities such as hospitals, nursing homes, and clinics are required to file institutional claim adjustment.

How to fill out institutional claim adjustment?

Institutional claim adjustments can be filled out by submitting a revised claim with the correct information and explanation for the adjustment.

What is the purpose of institutional claim adjustment?

The purpose of institutional claim adjustment is to ensure accurate billing and reimbursement for healthcare services provided.

What information must be reported on institutional claim adjustment?

On institutional claim adjustment, the corrected information must be reported along with any necessary documentation to support the adjustment.