Skip to main content

Some OHCA websites and applications may be temporarily unavailable beginning Wednesday, October 20 at 7:30 p.m. CST as we perform routine maintenance. If you are experiencing issues, please check back later. We apologize for any inconvenience.

Adjustments to Paid Claims


After review of both the claim and the Explanation of Benefits (EOB) Remittance Advice Report, a provider may determine that a claim needs to be adjusted. Providers may file adjustment requests to:

  • Correct billing or processing errors.
  • Correct inappropriate payments (overpayments and underpayments).
  • Supply additional information that may affect the amount of reimbursement.

Adjustments are classified in two separate categories, check-related (refund) or non-check related, and further categorized as full or partial. Refer to Chapter 9 of the Provider Billing Manual for more information.

Forms

Providers may initiate reconsideration of a paid claim by submitting an appropriate Adjustment Request Form to Oklahoma Medicaid.

  • HCA-15 - CMS-1500, Dental, Outpatient Crossover Part B Adjustment Request
  • Pharm-3 - Pharmacy Paid Claim Adjustment Request
  • HCA-14 - UB-92 and Inpatient/Outpatient Adjustment Request

Telephone request for adjustments are not allowed due to federal and state rules. For additional information or questions please Contact Us 1-800-522-0114, option 3, sub-option 1. Monday, Wednesday thru Friday 7:30 a.m. - 4:00 p.m., Tuesday 12:00 p.m. - 4:00 p.m.

Refunding or returning money

Refund checks must be written to the order of:

Oklahoma Health Care Authority
OHCA Finance Unit
P.O. Box 18299
Oklahoma City, OK 73154 

did you know?

Last Modified on Nov 10, 2020
Back to Top