481- Medicaid Submission Types - Public Consulting Group

Jun 05, 2023

Below is a grid of tips on when a corrected claim, void, resubmittal/adjustment are done.

Scenario	Type of Submission	Additional Information
Claim is billed for the first time to Medicaid	ORIGINAL	90-day file time from the original date of service Claims greater than 2 years old will not be considered even with delay reason codes. Delay reason codes must be utilized within 30 days of the extenuating circumstance coming under the control of the provider. Provider delays in working claims issues result in timely filing rejections/denials are not considered third-party processing delays.
Claim was either denied or rejected, was never paid by Medicaid, and information needs to be corrected	RESUBMITTAL	Medicaid requires claims to be corrected within 60 days of notification. Medicaid allows only 2 resubmissions to correct the issue(s), after 2 resubmittals the claim is no longer viable for payment.
Medicaid previously paid the claim, but something on the claim is incorrect (i.e., CPT, diagnosis code, provider, etc.) and it is less than 6 years from date of service	CORRECTED CLAIM	Corrected claims are also referred to as an “adjustment” by Medicaid. Causes correction of claim history and cancels the original claim payment. Adjustments are not eligible for delay reason codes.
Medicaid previously paid the claim, but something on the claim is incorrect (i.e., CPT, diagnosis code, provider, etc.) and it is greater than 6 years from date of service	CORRECTED CLAIM	For claims >6 years old, any partial overpayments need to be manually returned to Medicaid by sending a check with letter including TCNs, Medicaid CIN, DOS, Provider name, and billed amount detailing what CPT/HCPCS are being refunded and why. Both the check and the letter need to be sent to CSRA PO BOX 1353 Albany NY 12201 on company letterhead stating the claims are over 6Y and cannot be adjusted electronically.
Medicaid previously paid but the services were billed in error and need to be refunded to Medicaid and are less than 6 years from date of service	VOID	A void is a cancellation of the original claim history and payment. Any resubmittal is considered a new claim. A claim cannot be voided unless Medicaid has made a payment.
Medicaid previously paid but the services were billed in error and need to be refunded to Medicaid and are greater than 6 years from date of service	VOID	For claims >6 years old, any overpayments need to be manually returned to Medicaid by sending a check with letter including TCNs, Medicaid CIN, DOS, Provider name, and billed amount to CSRA PO BOX 1353 Albany NY 12201 on company letterhead stating the claims are over 6Y and cannot be voided electronically and the reason for void.

Article ID: 78, Created: 7/13/2026 at 6:08 AM, Modified: 7/13/2026 at 6:08 AM