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Printed Date: 9/22/2015
There is no need to appeal a claim if you have made a minor error or omission in filing the claim, which in turn caused the claim to be denied. In the case where a minor error or omission is involved, you may request that Palmetto GBA reopen the claim so the error or omission can be corrected rather than going through the written appeals process. Reopenings may be submitted in written form or in some cases over the telephone.
NOTE - Claims that are rejected as unprocessable (remark code MA130 on the remittance advice) cannot be reopened. Rejected claims must be corrected and resubmitted as a new claim.
What is considered minor errors or omissions and can be reopened:
Did you know these are specific modifiers that are considered simple claim corrections?
These modifiers can be added to a procedure as a simple claim correction when the correction will change the outcome of the overall claim.
Can I request a reopening using the Interactive Voice Response (IVR) system or through eServices?
Yes, procedure codes that have denied for coverage due to missing modifiers 25, 59 or 79 can be reopened using the IVR or eServices.
Should I Assume Everything Else Must Be Submitted In Writing
Yes, claims reopening process is specifically for simple corrections or omissions that do not require additional documentation. More complicated issues must be submitted in writing. The redetermination form is used for the 1st level appeal and the reconsideration form for the 2nd level appeal. Issues that should not be requested as reopenings include:
There may be instances where an issue cannot be resolved as a reopening (telephone or written). An issue may not be resolvable because:
Telephone reopening hours of operation are Monday thru Friday
8:30 a.m. - 12 p.m. open
12 p.m. - 1 p.m. closed
1 p.m. - 4:30 p.m. open
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Last Updated: 05/02/2018