Get Nm Adjustment/void Request 2018-2025

Filling out the NM Adjustment/Void Request form is an essential process for managing Medicaid claims effectively. This guide provides clear, step-by-step instructions to assist you in successfully completing the form online.

Follow the steps to complete the NM Adjustment/Void Request form.

1. Click ‘Get Form’ button to access the NM Adjustment/Void Request form and open it in your chosen editing tool.
2. In Section A, provide your provider information. You must enter your National Provider Identifier (NPI), ensuring it is exactly 10 digits.
3. Proceed to Section B, where you will enter the claim information. You will need to specify either the Client ID# or NM Provider ID, along with the Transaction Control Number (TCN), which should be 17 digits.
4. Move to Section C, where you must detail the reason for your request. Be sure to clearly outline the specific adjustments or voids required.
5. In Section D, enter the requestor's name. By signing below, you certify that you are authorized to make this request. Include your signature, email, phone number, and the date of the request.
6. Once all sections are completed accurately, save your changes. You may choose to download, print, or share the form as needed for your records or submission.

Complete your NM Adjustment/Void Request online today to ensure prompt processing of your Medicaid claims.