Im having trouble reversing a claim. What can I do?
If you are not able to reverse a claim electronically, contact your software vendor for an immediate reversal. If your system will not allow a reversal, you will need to submit a claim reversal on paper. Use adjustment form 13-715 Adjustment Request Form 525-109. In the field that asks for the ICN, use the RxClaim number or MMIS ICN from your Remittance Advice. The RxClaim number for your transaction can be found in the Authorization Number field (503-F3) of your POS response. You can access the form at: http://www.dshs.wa.gov/msa/forms/eforms.
