Medicare Blog

how do i reopen a claim for medicare on the phone?

by Estrella Morar DDS Published 3 years ago Updated 2 years ago
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The DME MAC telephone reopening number is 1-866-813-7878. This line is in service Monday through Friday, from 7 AM to 5 PM, Central Standard Time. Note: The easiest, fastest, and most efficient way to complete a Telephone Reopening request is via the myCGS Web Portal.

Full Answer

How do I reopen a Medicare claim?

Phone 1-800-MEDICARE (1-800-633-4227) For specific billing questions and questions about your claims, medical records, or expenses, log into your secure Medicare account, or call us at 1-800-MEDICARE.. If you want Medicare to be able to give your personal information to someone other than you, you need to fill out an "Authorization to Disclose Personal Health Information."

How do I file a D9 reopening request for Medicare?

Oct 24, 2021 · Providers must wait at least three business days, after receiving the Electronic Remittance Advice (ERA), before initiating a Reopening request. Providers must check claim status through Interactive Voice Response (IVR) or NMP. Claims with message MA130 or N704 on ERA or SPR must be resubmitted as a new claim.

How do I complete a telephone reopening request?

Nov 04, 2020 · Part B clerical reopening requests may be submitted online through SPOT, the reopening gateway, or via telephone through the interactive voice response (IVR) system. Option 1: Submit reopenings online using SPOT

How do I request a claim correction or claim reopening?

To request a reopening, you will report a new Type of Bill (TOB), XXQ, along with condition codes to indicate that the claim is a Request for Reopening. Effective on or after January 1, 2016, all providers must use the new reopening process, TOB XXQ, when a correction is to be made beyond the timely filing limit (one year from the through date of the service).

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How do I resubmit my Medicare claim?

To submit a corrected claim to Medicare, make the correction and resubmit it as a regular claim (Claim Type is Default) and Medicare will process it.Apr 13, 2022

What is the resubmission code for a corrected claim for Medicare?

code 7
If you are submitting a void/replacement paper CMS 1500 claim, please complete box 22. For replacement or corrected claim enter resubmission code 7 in the left side of item 22 and enter the original claim number of the claim you are replacing in the right side of item 22.

What is a Medicare reopening request?

A reopening is a remedial action taken to change a binding determination or decision that resulted in either an overpayment or an underpayment, even though the determination or decision was correct based on the evidence of record. Reopenings are separate and distinct from the appeals process.

How do I correct a Medicare billing error?

If the issue is with the hospital or a medical provider, call them and ask to speak with the person who handles insurance. They can help assist you in correcting the billing issue. Those with Original Medicare (parts A and B) can call 1-800-MEDICARE with any billing issues.Jan 6, 2022

What is the process for claim resubmission?

When you resubmit a claim, you are creating a new claim and sending it to the payer. The payer receives the claim and treats it as a new claim. To resubmit a claim, it needs to be placed back into the Bill Insurance area.Jun 20, 2018

What is resubmission code 8 on a claim?

Complete box 22 (Resubmission Code) to include a 7 (the "Replace" billing code) to notify us of a corrected or replacement claim, or insert an 8 (the “Void” billing code) to let us know you are voiding a previously submitted claim.Apr 8, 2015

What is a Medicare clerical reopening?

A clerical error/omission reopening is an action taken to change an initial determination to correct minor errors or omissions outside of the Medicare appeal process.

How long does Medicare take to process a claim?

Claims processing by Medicare is quick and can be as little as 14 days if the claim is submitted electronically and it's clean. In general, you can expect to have your claim processed within 30 calendar days. However, there are some exceptions, such as if the claim is amended or filed incorrectly.

What to do if Medicare denies a claim?

An appeal is the action you can take if you disagree with a coverage or payment decision by Medicare or your Medicare plan. For example, you can appeal if Medicare or your plan denies: A request for a health care service, supply, item, or drug you think Medicare should cover.

Why would Medicare deny a claim?

Medicare may issue denial letters for various reasons. Example of these reasons include: You received services that your plan doesn't consider medically necessary. You have a Medicare Advantage (Part C) plan, and you went outside the provider network to receive care.May 18, 2020

How do I void a Medicare 1500 claim?

To complete a void or an adjustment, the claims reference numbers from your remittance advice will be needed. All lines submitted on a claim form will have an individual reference number assigned as each line is evaluated separately for payment. A void request will void all paid lines on the original claim form.Oct 21, 2021

Request a Reopening

Note: Unprocessable claims with Remittance Advice (RA) message MA 130 cannot be reopened. ("Your claim contains incomplete and/or invalid information, and no appeal or Reopening rights are afforded because the claim is unprocessable. Submit a new claim with the complete/correct information.")

Items Too Complex for a Reopening

Submit the below as a Redetermination request with supporting documentation.

Written Reopening

Suppliers may submit a Written Reopening request via mail, fax, or as a Self-Service Reopening in NMP.

Claim Correction Reopening

When the need for a claim correction is discovered and the claim is beyond the timely filing limit (1 calendar year from the "through" date on the claim), a reopening request (type of bill (TOB) XX Q) must be submitted to remedy the error.

Untimely Filing

Claims are rejected for untimely filing when the claim is submitted 12 months after the date the services were furnished. The Centers for Medicare & Medicaid have established exceptions to the one calendar year time limit. For additional information, refer to the Medicare Claims Processing Manual, CMS Pub. 100-04, Ch. 1, §70.7.

56900 Reopenings

Claims are denied with reason code 56900 when the claim was selected for an additional development request (ADR), but the medical documentation was not received by CGS, or was not received timely.

How to correct your claim

Minor errors or omissions may be corrected outside of the appeals process.

Option 1: Submit reopenings online using SPOT

The SPOT offers registered users the time-saving advantage of correcting clerical errors in their eligible Part B claims quickly, easily, and securely -- online.

Option 2: Submit reopenings through the reopening gateway

The Claim Reopening Gateway is an interactive tool that requires no registration or enrollment, and offers a quick and easy way to make Part B claim corrections directly on the First Coast website. For instructions on how to use the reopening gateway, view the help guide.

Option 3: Submit reopenings on the telephone with the IVR

If you don’t have online access, you may submit your Part B clerical reopening request through First Coast’s IVR system. Although the IVR offers the same primary request types as the SPOT, the IVR offers the additional option of making history corrections to your claim.

Electronic or Direct Data Entry

Electronic or Direct Data Entry (DDE) claims for reopening requests must include the following:

DDE Claims Only

Report a reopening ‘Adjustment Reason Code’ on claim page 3 (MAP1713):

Reopenings that require 'Good Cause'

Reopenings that require ‘Good Cause’ must have remarks on claim page 4 (MAP1714). ‘Good Cause’ remarks must be the first remarks on the claim and must be formatted as shown below without the parenthetical explanation, failure to follow the required formatting will result in your claim returning to provider (RTP) for reason code 39995.

Scenarios not accepted as a reopening

The following scenarios, submitted after the claim submission timely filing (one year from the date of service) has expired, will not be accepted as a reopening request and will RTP with reason code 39997:

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Claim Correction Reopening

Untimely Filing

  • The DME MAC telephone reopening number is 1-866-813-7878. This line is in service Monday through Friday, from 7 AM to 5 PM, Central Standard Time. Note: The easiest, fastest, and most efficient way to complete a Telephone Reopening request is via the myCGS Web Portal. Use the telephone reopening process to resolve minor errors or omissions involvin...
See more on cgsmedicare.com

56900 Reopenings

Ordering/Referring Denial Reopenings

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