Adjustment reason requests include additional or corrected data that was not on the original claim.
Use our Quick Claim Submission Guide to review guidelines for common claim scenarios.
Minnesota Statute section; 62J.536 requires Minnesota providers to submit adjusted claims in the electronic 837 format.
* Please check applicable reason
Provide a description of the corrected coding.
Documentation supporting your adjustment and description are required.
Attach documentation to support your request
The file/s have been attached and will be submitted with this form, but the attached file names are not available to display at this time.
You may continue and submit this form if you have attached the appropriate documentation, or click cancel to start over.
