Claims Billing Reversal (B2) Transaction

Pharmacies use this transaction to cancel a claim previously processed as paid. The following payer sheets are available:

• Claim Billing Reversal (B2) Transaction Payer Sheet
  • Reversal Request
    • Programs: Medicaid, CSHCN, HTW, KHC
  • Accepted Response
  • Rejected Response

The following fields must match on the original paid claim and on the reversal request for a successful claim reversal:

• "Service Provider ID" (201-B1)
• "Prescription/Service Reference Number" (402-D2)
• "Product/Service ID" (407-D7)
• "Date of Service" (401-D1)