Revision : 1
Record Description : Record contains history only adjustments as the result of the provider reimbursing Medicaid by a check beginning with a processing date of July 1, 2007 or after. It includes ODJFS adjustment request forms 6766 and 6767, and nursing facility payment and adjustment authorization forms 9400, check deposit records, copies of checks, and letters documenting overpayments. It may also include documents sent to and from the Attorney General’s Office, state and federal auditors or Surveillance and Utilization Review relative to the overpayment.