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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 can request that Railroad Medicare 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, over the telephone or through our eServices online portal.
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 Type of Claims can be Reopened?
Claims with minor errors and omissions can be reopened, such as:
Please Note: Claims that have been rejected as unprocessable (remark code MA130 on the remittance notice) cannot be reopened. Those claims must be corrected and resubmitted as new claims.
Are There Specific Modifiers That Qualify for a Telephone Reopening?
Yes. The following modifiers can be corrected through a claim reopening:
Can I request a reopening using the Interactive Voice Repose (IVR) system or through eServices?
Yes, procedure codes that were denied on National Correct Coding Initiative )(NCCI) edits or global surgery edits can be reopened using the IVR or eServices when the addition of modifier 25, 59 or 79 is appropriate.
Should I Assume Everything Else Must Be Submitted In Writing?
Yes, that is a safe assumption. The claim reopening process is specifically for simple corrections or omissions that do not require additional documentation. More complicated issues must be sent in writing using the appropriate form (the Redetermination form for first level appeal; Reconsideration form for a second level appeal). This includes:
There may be instances where an issue cannot be resolved as a reopening (telephone or written). An issue may not be resolvable because:
What Else Should I Know About Reopening Claims?
The Railroad Medicare Telephone Reopening Line Contact Information
Call 888-355-9165 Monday through Friday from 8:30 a.m. to 4:30 p.m. for all time zones, with the exception of Pacific Time, which receives service from 8 a.m. to 4 p.m. For reopenings, first press 4, and then to request a telephone reopening to correct minor errors or omission, press 0.
The Railroad Medicare Fax Reopening Line Information
You can submit your Reopening request by faxing your documentation to (803) 462-2218.
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Last Updated: 05/02/2018