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Void (“Take-Back”) Waiver and Alternative Care (AC) Service Claims for Fee-for-Service

Revised: 01-27-2015

Effective January 1, 2011:

Providers must:

  • 1. Submit their own void (take-back) claims electronically for wavier and AC claims. Refer to the MN–ITS User Guide for Voiding a Claim using MN–ITS.
  • 2. Submit a partial void of a claim by replacing the claim previously paid incorrectly. Refer to the MN–ITS User Guide for Replacing a Claim using MN–ITS.
  • Lead agencies must follow the steps below when requesting voids for the purpose of adjusting a service authorization/agreement:

  • 1. Contact the provider and request them to do their own void.
  • 2. After waiting 7 days, if the claims are not voided, you may request, on behalf of the provider, that the claims be voided:
  • a. Complete the Credit Claim Void (take-back) Request (DHS-6207) form and submit it to MHCP by fax at 651-431-7616; or
  • b. Send an email with the Credit Claim Void (take-back) Request form attached to dhs.void@state.mn.us, enter “Attn: SA Claim Void” in the subject line.
  • 3. After the claim is voided, check the service agreement to make sure the line item’s paid units and/or dollar amounts were adjusted before making changes to the line item (if changes are needed).
  • Note: Any voids for Managed Care Organizations (MCOs) refer back to the Health Plan.

    MHCP will:

  • 1. Void county-initiated claims in the order received.
  • 2. Not process incomplete claim void requests.
  • 3. Report claim void transactions in the Reversal section of the provider’s remittance advice (RA).
  • Additional Resources

    MN–ITS
    MHCP X12/NCPDP Submitters

    MHCP Provider Manual Billing Policy; MN–ITS and Electronic Billing

    If you have questions about this information, call the MHCP Provider Call Center at 651-431-2700 or 1-800-366-5411.

    Sign up to receive Provider Updates and other MHCP notices in your e-mail account.

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    © 2017 Minnesota Department of Human Services Updated: 1/27/15 9:30 AM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 1/27/15 9:30 AM