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 | Special Project
- 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
- Overpayments or reductions in payment. Submit request on Overpayment Refund Form
- 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 Self-Service Reopening webpage for details
To submit a Written Reopening special project request, the claim(s) affected must be finalized. (i.e. SPR or ERA has been generated)
To avoid a possible dismissal, follow the instructions below.
Submit a Written Reopening request by mail, fax, or via NMP
Mail or fax: Complete Medicare DME Reopening Request Form. See Written Reopening Requests mailing address or Appeals - Reopening and Redeterminations fax number. One request form per beneficiary. If supplier has a list of beneficiary claims, may attach spreadsheet(s)
Inlclude below in Comments section of form
- "Special Project Request - See attached spreadsheet"
- Total number of pages including coversheet
- Inlclude below in Comments section of form
NMP Self-Service Reopening: Request details must be completed within NMP. Supplier may attach spreadsheet(s) when there is a list of beneficiary claims
- NMP is limited to submission of 70 megabyte files so check file size of spreadsheets before submission
- Mail or fax: Complete Medicare DME Reopening Request Form. See Written Reopening Requests mailing address or Appeals - Reopening and Redeterminations fax number. One request form per beneficiary. If supplier has a list of beneficiary claims, may attach spreadsheet(s)
Attach a Spreadsheet, if applicable
- Access Reopening Spreadsheet Template
- JA and JD claims cannot be on same spreadsheet, even if for same PTAN. Suppliers must submit separate requests for JA and JD
- Spreadsheet must be typed with font large enough to be easily read. Hand written documents are not accepted
- Do not add any coloring to spreadsheet. This is not accepted
Spreadsheet must include:
- Supplier NPI and PTAN
- Beneficiary Full Name
- Beneficiary Medicare Number
- HCPCS Codes
- CCN - list each claim number only once on spreadsheet
|Decision||Type of Correspondence|
Last Updated Tue, 11 Feb 2020 12:02:47 +0000