Reopening - JD DME
The Reopening process allows suppliers to correct clerical errors or omissions without having to request a formal appeal. Initiate a request online via the Noridian Medicare Portal (NMP), telephone, or in writing.
Access the below Reopening related information from this page.
- Request a Reopening
- Items Too Complex for a Reopening
- Telephone Reopening
- Written Reopening: General
- Reopening Decision Correspondence
|Time Limit for Filing Request||Time Limit to Complete Request||Filing Options|
|One year from initial determination date or after one year from receipt date due to overpayment via clerical error omissions||60 days from receipt date|
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.")
Before submitting a Reopening request, suppliers must research the claim denial reason (see Standard Paper Remittance (SPR) or Electronic Remittance Advice (ERA), call Interactive Voice Response (IVR), access NMP, or contact Supplier Contact Center) and determine the proper way to correct it.
Suppliers must wait three business days, following ERA or SPR receipt, before calling Telephone Reopenings or submitting a request via NMP.
Do not resubmit a claim after submitting a Reopening request.
Submit the below as a Redetermination request with supporting documentation.
- Overutilization denials that require supporting medical records
- Certificate of Medical Necessity (CMN) issues (applies to Telephone Reopenings only)
- Durable Medical Equipment Information Form (DIF) issues (applies to both Written and Telephone Reopenings)
- Oxygen break in service (BIS) issues
- Medicare Secondary Payer (MSP) issues
- Claims denied for timely filing (older than one year from initial determination)
- A good cause for late filing request must be submitted as a Written Reopening request. Such requests are not accepted via Telephone. See CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 29, Section 240.1
- Complex Medical Reviews or Additional Documentation Requests (ADRs)
- Change in liability
- Recovery Auditor-related items
- Certain modifier changes or additions: EY, GA, GY, GZ, K0 - K4, KX, RA (cannot be added), RB, RP
- Certain HCPCS codes: E0194, E1028, K0108, K0462, L4210, All HCPCS in Transcutaneous Electrical Nerve Stimulator (TENS) LCD, All National Drug Codes (NDCs), miscellaneous codes and codes that require manual pricing
Note: The above is not an all-inclusive list.
To complete a Telephone Reopening, a caller must provide the below.
|Verified by Customer Service Representative (CSR) or IVR||Verified by CSR|
Suppliers may submit a Written Reopening request via mail, fax, or as a Self-Service Reopening in NMP.
|Mail or Fax||Self Service Reopening via NMP|
|Complete/submit Medicare DME Reopening Request Form
Request details must be completed in NMP. Log In Now. One request per beneficiary.
View Portal Guide webpage for details
|Decision||Type of Correspondence|
Last Updated Thu, 13 Jan 2022 17:41:06 +0000