from Provider Update - Spring 2006
Steps to follow to have a claim reviewed or reconsidered
Do you have a claim(s) that you would like to have reviewed or reconsidered?
Follow these steps:
- Complete a Medicaid Claim Inquiry Response Form (HCA-17)*.
- Attach the claim and documentation (offi ce notes, medical record documentation, proof of timely fi ling, etc.).
- Mail to OHCA Provider Services
P.O. Box 18506
Oklahoma City, OK 73154
Claims that do not have the HCA-17 form attached will be sent to process without review.
* To obtain a copy of the Medicaid Claim Inquiry Response Form (HCA-17), visit our Web site at http://www.okhca.org/provider/forms/pdfl ib/hca-17.pdf or call 1-800-522-0114, option 1, to request a copy.