Get Wps Corrected Claim Form

Filling out the Wps Corrected Claim Form online can streamline the process of correcting claims for services that have been paid or partially paid. This guide provides clear instructions on how to complete the form accurately and effectively, ensuring that all necessary information is included and submitted correctly.

Follow the steps to complete the Wps Corrected Claim Form online:

1. Press the ‘Get Form’ button to access the Wps Corrected Claim Form and open it in your preferred editor.
2. Fill in the provider name, tax ID, and address in the designated fields to identify the service provider for the claim.
3. Enter the member/participant ID and full name in the appropriate sections to specify the individual associated with the claim.
4. Provide the original claim number to reference the claim that needs correction.
5. Indicate whether the correction is an increase or decrease in the amount by checking the appropriate box.
6. Fill in the original amount and new amount for clarity on the adjustment being made.
7. If applicable, enter the billed amount, original units, new units, and units billed to provide detailed information on the claim adjustment.
8. Specify the reason for the change in the provided text box to clarify the nature of the correction.
9. Update the original date and new date, as well as the date of service, if there are any changes.
10. Complete the authorization section by entering the original and new authorization codes, if necessary.
11. If relevant, enter the original and new codes pertaining to the CPT/HCPCS/REV.
12. Attach the original remittance advice and any other required documents, such as the original EOMB or EOB, to support your claim.
13. Finally, review all the information for accuracy, then save your changes. You may choose to download, print, or share the completed form as needed.

Complete the Wps Corrected Claim Form online today to ensure your corrections are processed efficiently.