Providers may request a Reopening of their Medicare claim over the telephone. Requests to reopen an initial claim to correct minor errors or omissions can be made by contacting our toll-free line at (866) 324-3073 between 8:30 a.m. to 4:30 p.m. (EST, CST, MSP), and 8:00 a.m. to 4:00 p.m. (PST), Monday through Friday. A maximum of three (3) requests can be handled during the same telephone call.
Requests for claim status or questions about why a claim denied are considered inquiries, not reopenings. Calls about an inquiry will be referred back to the Provider Service Center for assistance.
NOTE: If your claim has been rejected as unprocessable (MA130), a corrected, new claim must be submitted. Corrections will not be made on this line.
When calling our office to request a claim correction, please be prepared to provide the following information:
- The provider's/physician's/supplier's name and identification number or National Supplier Clearinghouse number;
- Beneficiary last name, first initial; and
- Medicare HICN
NOTE: The above items must match exactly. If not, you may be instructed to research this information and call back or write in for your request.
Claim corrections can include:
- Mathematical or computational mistakes;
- Transposed procedure or diagnostic codes;
- Inaccurate data entry;
- Misapplication of a fee schedule;
- Computer errors; or
- Denial of claims as duplicates which the party believes were incorrectly identified as a duplicate.
- Incorrect data items, such as provider number, use of a modifier or date of service (month and day only).
The addition/correction of the listed modifiers may be handled as reopenings on this line.
| HCPCS Modifiers |
AA, AD, AT, E1, E2, E3, E4, GA, G8, G9, LT, KD, KX, QJ, QK, QR, QW, QX, QY, QZ, Q3, RT, SG, TC |
| CPT Modifiers |
21, 25, 26, 50, 51, 54, 57, 58, 59, 66, 73, 74, 76, 77, 78, 79, 80, 82 |
All other modifiers may be submitted, with supporting documentation, as written requests for a Reopening or a Redetermination.
The following issues are redeterminations and must be submitted in writing:
- Limitation on liability;
- Medical necessity denials and reductions; or
- Analysis of documents such as operative reports and clinical summaries
- Claims requiring the input of medical staff or other entities outside of the reopenings department and 'big box' cases.
A reopening to add items or services that were not previously billed will not be completed. A written request must be filed.
*** The contractor has discretion in determining what meets the definition of a reopening and therefore, what could be corrected through a reopening.