Reopening Request Checklist
Before requesting a Reopening, use the below checklist to determine if a Reopening is the correct choice.
| Yes/No | Requestor Action |
| | - Do you have a Noridian DME Standard Paper Remittance (SPR) or Medicare Electronic Remittance Advice (ERA) for the claim(s) in question?
- If not, submit request to Durable Medical Equipment Medicare Administrative Contractor (DME MAC) identified on ERA or SPR
|
| | - Was the claim(s) in question denied as unprocessable?
- If so, correct and resubmit new claim(s)
Note: Unprocessable claims with Remittance Advice (RA) message MA130 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.") |
| | - Is the claim denial due to a minor clerical error or omission (e.g., units of service, service dates, HCPCS coding, diagnosis codes, etc.)?
- If so, a Reopening request is appropriate. Select a method below.
|
| | - What is the ERA or SPR date for the initial determination? Has more than one year lapsed since that date?
- If so, requestor must submit a written reopening request detailing "good cause" reason for filing late
|
| | - Has requestor reviewed all information listed above?
- If so, request a Reopening. Select a method:
|
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