Claims Inquiry Process Clarifications

Underpayment/Overpayment Adjustments and Voids

A Claims Inquiry Form (CIF) adjustment should be used to correct both underpayments and overpayments. However, this transaction type is different than requesting a full payment recovery, which is a void. A CIF adjustment is a one-step process. If requesting an adjustment for an underpaid or overpaid claim, the adjustment is completed in one transaction, with the adjudication results appearing on a future Remittance Advice Detail (RAD). The corrected Claim Control Number (CCN) will appear as a credit and a debit, and will be reflected on the same RAD.

A CIF void may be requested to fully recover or recoup monies paid. In many instances, the provider’s goal was to return funds to a Medi-Cal or specialty program. The CIF void accomplishes that in one step. However, there are cases in which the provider wants to void the original payment and submit a corrected claim. The CIF void is largely an automated process and cannot perform two functions. As a result only the void can be processed.

Providers requiring a void and subsequent resubmission of a corrected claim, use a two-step process. First, the CIF void must be submitted to recoup the full payment. Once the void appears on a future RAD, the provider completes the secondary step of submitting an Appeal to request processing of the corrected claim.

The Appeal must be filed within 90 days from the date indicated on the RAD on which the void appeared. The Appeal must include a corrected claim copy, a copy of the RAD that indicated the payment retraction, and any other supporting documentation.