Before requesting a Reopening, use the below checklist to determine if a Reopening is the correct choice.
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- 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
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- 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.")
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- 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.
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- 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
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- Has requestor reviewed all information listed above?
- If so, request a Reopening. Select a method:
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