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Financial (mail with checks/check returns)

Financial (mail with checks/check returns)

Conduent State Healthcare and the Division of Medicaid have received numerous inquiries from providers regarding the procedures for returning money to Medicaid. The most efficient way to return money to Medicaid is for providers to submit an adjustment/void request for each claim to be voided. Boxes 1 through 6 of the adjustment/void request form must be completed. If providers choose not to have the overpayments deducted from future claims payments, a personal check should be attached to the adjustment/void request form. Checks should be make payable to: Division of Medicaid. If a provider has an extenuating circumstance which makes completing the adjustment void request unfeasible, the following information should be included with their personal check:
  • Provider ID number
  • A list of TCNs (transaction control numbers) to be voided
  • Beneficiary ID numbers
  • Dates of service
  • Payment amount
  • Remittance advice date
Please note the information requested in the paragraph above is needed for each claim to be voided.The completed adjustment/void forms or the documentation referenced above with checks attached should be mailed to:
Division of Medicaid
Attention: Bureau of Financial Reporting
550 High Street
Suite 1000
Jackson, MS 39201
Adjustment void forms with no check attached may be submitted to Conduent State Healthcare, P. O. Box 23077, Jackson, MS 39225. If you have any questions, please contact Conduent Provider Services at 1-800-884-3222.