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Printed Date: 9/22/2015
Telephone reopenings are available to quickly correct minor clerical errors over the phone. But the resolution of complex issues, such as denials based on local or national coverage determinations or denials on codes that require manual pricing, cannot be conducted over the phone. A redetermination request or a written reopening request may be needed in those instances. If your claim is too complex to be handled over the telephone, the telephone reopening representative will advise you that a telephone reopening cannot be conducted.
To ensure the requirements of the Privacy Act are met, you must provide specific information to us prior to the representative conducting the telephone reopening.
These items must match the information on our files. If the information provided does not match what is in our files, the representative may not be able to continue with the reopening.
We receive numerous requests via the telephone reopening line to correct a claim based on receipt of an Electronic Remittance Advice (ERA). While the ERA saves time by making the electronic information available to you quickly, in many instances claim corrections cannot be initiated because the claim has not fully finalized in our processing system. The claim is only available to us to make a correction once it reaches the final processing step/stage in our system.
Once you receive your ERA and before calling our telephone reopening line, please note the CHECK/EFT date on your ERA. Your claim will not be in an adjustable location until the business day after the date on your ERA. The claim must go through one more system cycle to be complete and available for correction.
By checking the CHECK/EFT date on your ERA, you can save time and resources if you contact us for a correction after this date. This will ensure your claim has fully processed through our system and will be available for the telephone reopening associates to quickly make your correction.
Claims which have been rejected as unprocessable (remark code MA130) should be corrected and resubmitted as new claims. Rejected claims cannot be corrected on the telephone reopening line.
If you need assistance determining why your claim rejected, check the Palmetto GBA Denial Resolution Tool by selecting the 'Forms/Tools' button on the top of this web page. The Denial Resolution Tool is alphabetized by type of service and reason for denial. After checking this tool, if you need assistance to understand why your claim was rejected as unprocessable, call the Provider Contact Center at 855-696-0705.
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Last Updated: 02/16/2018