Self Service Reopenings

Suppliers may create a self-service reopening for the following:

  • Add or remove diagnosis codes
  • Add or replace modifiers
  • Reprocess a claim
  • Billed Amount
  • Procedure Code and Billed Amount
  • Procedure Code, Modifier, and Billed Amount
  • Units and Billed Amount
  • Units, Modifier and Billed Amount
  • Date of Service
  • Place of Service (can only be corrected to 12)

A self-service reopening is submitted by performing a claim status inquiry first. The Self-Service Reopening link is located under Related Inquiries.

This image shows where the Self Service Reopenings link is on the Nordian Medicare Portal.

Step 1: Selection

After selecting the link, if the message "Selected claim is not eligible for Self-Service Reopening. Please select another claim or submit a written reopening or redetermination" displays, this indicates one or more of the following requirements were not met. The claim:

  • Has not been appealed or adjusted previously
  • Cannot be under review
  • Cannot be denied as unprocessable (MA-130)
  • Not deemed too complex - View the Items too complex for Reopenings
  • Cannot be paid
  • Remittance date is within one year of current date
  • Must be finalized

If all of these requirements are met, the reopening begins. First, select the Adjustment Type:

  • Billed Amount
  • Date of Service
  • Diagnosis
  • Modifier
  • Place of Service
  • Procedure Code and Billed Amount
  • Procedure Code, Modifier and Billed Amount
  • Reprocessing
  • Units and Billed Amount
  • Units, Modifier and Billed Amount

Note: If a combination option is chosen (ex. Procedure Code, Modifier and Billed Amount) it is not required to correct all elements. If only the Procedure Code needs correcting, the other items will remain as is.

Next, check the box next to the claim lines the reopening pertains to:

This image shows the types of adjustments that can be selected when performing a self service reopening.

Step 2: Corrections

Billed Amount

If billed amount was selected, suppliers may decrease, or increase the amount submitted.

This image shows where the billed amount can be corrected during a Self Service Reopening.

Date of Service

Suppliers may change the month and day of service listed on the claim. The year cannot be changed. 

Note: Dates of Service changes cannot be prior to the receipt of the claim to MedicareThis image shows where the Date of Service can be corrected on a Self Service Reopening.

Diagnosis
Suppliers may change any of the diagnosis codes listed on the claim.

Note: Diagnosis codes must be entered in A-D, current functionality does not allow diagnosis code fields E-L at this time.

This image shows where the diagnosis code can be corrected during a Self Service Reopening.

Modifier

If Modifier was selected, suppliers may add or replace the modifiers listed on the claim.This image show where the modifier can be corrected during a Self Service Reopening.

Place of Service

When selecting Place of Service, only the entire claim can be corrected to 12.

This image shows where Selecting All will make the Place of Service correction to the entire claim.

Procedure Code and Billed Amount

Suppliers are able to update the Procedure Code and Billed amount listed on the claim.

This image shows where the procedure code and billed amount can be corrected during a Self Service Reopening.

Procedure Code, Modifier and Billed Amount

Suppliers may change the Procedure Code, Modifier, or Billed Amount listed on the claim.

This image shows where the procedure code, modifier and billed amount can be corrected during a Self Service Reopening.

Reprocess
Suppliers may choose to reopen the claim as it was originally billed.  No changes or corrections will be made to the claim.

This image shows how a claim can be reprocessed during a Self Service Reopening.

Units and Billed Amount

Changes can be made to the Units and Billed Amount listed on the claim.

            *Note – Billed amount cannot exceed $99999.99This image shows where units and billed amount can be changed during a Self Service Reopening.

Units, Modifier and Billed Amount

Changes can be made to the Units, Modifier, and Billed Amount listed on the claim.

            *Note – Billed amount cannot exceed $99999.99

This image shows where modifiers, units and billed amounts can be corrected during a Self Service Reopening.

Step 3: Submission

Step 3 provides the user with updated claim lines.  Suppliers must check the box stating "I verify the changes are accurate", and then select Confirm Changes.

            *Note, corrections will be shaded in a light gray

This image shows how the corrections will display, and where to verify the changes are accurate and choose the Confirm Changes button.

Step 4: Confirmation

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

This image shows the Self Service Reopening Confirmation screen on the Noridian Medicare Portal.

Follow-up

To follow-up on the processing of the reopening, view the adjusted claim under Claim Status. DME suppliers may view the adjusted claims immediately. These adjustments display with the claim number ending in the number ‘1'.

This image shows how a claim will display on the Claim Status inquiry once a Self Service Reopening has been performed.

Suppliers may call Customer Service with questions or for assistance. Do not call Telephone Reopenings; this line is for reopening claims only.

Last Updated Oct 09, 2018