Recoupment Request (Part B)

The following instructions provide direction for submitting a Recoupment Request for Part B users in the Noridian Medicare Portal.

Step 1: Selection

After "Yes" is answered for the question "Is this an overpayment refund?" continue on with the following steps.

Answer the following questions:

  • "Do you have a Corporate Integrity Agreement with the OIG"
    • If Yes, the claim is not eligible for an adjustment
    • If No, continue on
  • "Have you received notification that this claim is under review by an external auditor (SMRC, ZPIC, RAC)?"
    • If Yes, the claim is not eligible for an adjustment
    • If No, continue on

Select Adjustment Type(s): Choose all that apply.

  • Billed Amount
  • Billed in Error
  • Date of Service
  • Diagnosis
  • Modifier
  • MSP Type
  • Place of Service
  • Procedure Code
  • Referring Provider
  • Rendering Provider
  • Reprocessing
  • Units

If Billed in Error is selected, a Billed in Error Reason Code needs to be selected

  • Billing Error
  • Duplicate
  • Code Change
  • Corrected Date of Service
  • Not our Patient
  • Services Not Rendered
  • Modifier Add/Remove
  • Insufficient Documentation
  • Patient in HMO
  • Veteran's Administration Paid
  • Medical Necessity
  • Patient in Skilled Nursing Facility
  • PacMed

Select the claim line(s) that the adjustment will apply to.

Use the check box if the claim was Billed in Error or Reprocessing

Note: Both cannot be selected, but the box can be left blank.

Once completed, choose Next.

Step 2: Corrections

All fields that are able to be adjusted are opened to make corrections. Once the correction has been made, choose Next.

Step 3: Submission

Step 3 provides the user with updated claim lines based on the changes selected. Review the changes, select the checkbox to verify the changes are accurate and choose Confirm Changes.

Note: Error messages will be displayed if the claim cannot be modified with further instructions.

Step 4: Confirmation

Step 4 provides the Confirmation Number of the request. This indicates the reopening was submitted and will be processed.

 

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